Implementing and evaluating the impact of novel mobile harm reduction services on overdose among women who use drugs: The SHOUT study.

项目摘要 2020年近92，000名美国人死于药物过量，主要是由致命的药物供应驱动 以合成阿片类药物为主（即，芬太尼和芬太尼类似物）和增加的兴奋剂相关死亡。我们 已经记录了吸毒妇女（WWUD）（N=385）经历的这一流行病的严重程度， 巴尔的摩市，谁报告的经历过量（28%），目睹了致命的过量（35%）， 在过去的6个月内目睹了非致命性过量（52%）。我们还记录了一些 结构脆弱性（即，无家可归、饥饿），精神健康疾病（即，创伤后应激障碍，抑郁症）， 人际暴力，以及混乱的吸毒模式（即，多物质使用，）间接和直接驱动 女性的用药过量和其他发病率的明显风险（即，HIV、HCV）。然而，WWUD经历了许多 接受必要的医疗和行为服务的障碍，这些服务可以降低他们过量用药的风险， 其他危害，COVID-19大流行加剧了障碍。我们建议进行呐喊 （持续性损害减少拓展）研究，1型混合有效性-实施设计，用于评估 以WWUD为中心的移动的危害减少服务对非致命性过量的影响和实施情况， 从巴尔的摩市和县社区招募的WWUD（N=400）中的临床护理参与 新的移动的移动服务。移动的广告是一个现有的低障碍，外展计划，服务于其他 社区并提供减少伤害的供应（即，无菌注射器、纳洛酮、避孕套），必需品（即， 食物，衣服），创伤知情的微观咨询，和必要的转介研究的目的是：1）适应和 扩展移动的服务，以确定诱发（即，药物使用模式）和使能（即，获得 信任的卫生服务）的因素，促进或阻碍利用减少危害的服务，雇用- 与WWUD的深度访谈（N=40）和与移动的调查人员的关键线人访谈（N=5）; 2）评估 扩大移动的范围对非致命性药物过量和临床服务参与（包括药物 在从移动的社区招募的WWUD（N=400）中， 是新实现的;以及3）表征使用Reach的移动的业务的实现， 有效性、采用、实施、维护（RE-AIM）框架，为未来的实施提供信息 and scale规模up. SHOUT研究将对评估以下影响的文献做出重大贡献： 在WWUD中开展针对过量用药问题的量身定制的低障碍移动的外联活动。该研究的相关性和可持续性将 通过与社区发展委员会的伙伴关系、社区咨询委员会的投入以及长期支持， 长期合作组织和卫生部门利益相关者以及成本效益 分析.该提案高度响应了RFA DA-22-046对可复制伤害减少的强调 针对得不到充分服务的吸毒过量高危人群的服务提供模式。

Project Summary Nearly 92,000 Americans died of drug overdoses in 2020, primarily driven by a lethal drug supply dominated by synthetic opioids (i.e., fentanyl and fentanyl analogs) and increased stimulant-related deaths. We have documented the magnitude of this epidemic experienced by women who use drugs (WWUD) (N=385) in Baltimore City, who reported high rates of experiencing an overdose (28%), witnessing a fatal overdose (35%), and witnessing a non-fatal overdose (52%) in the past 6 months. We have also documented a number of structural vulnerabilities (i.e., homelessness, hunger), mental health morbidities (i.e., PTSD, depression), interpersonal violence, and chaotic drug use patterns (i.e., polysubstance use,) that indirectly and directly drive women’s distinct risk of overdose and other morbidities (i.e., HIV, HCV). Yet WWUD experience numerous barriers to receiving necessary medical and behavioral services that can reduce their risk of overdose and other harms, with barriers amplified by the COVID-19 pandemic. We propose conducting the SHOUT (Sustained Harm reduction OUTreach) study, a type 1 hybrid effectiveness-implementation design to evaluate the impact and implementation of WWUD-centered, mobile harm reduction services on nonfatal overdose and clinical care engagement among WWUD (N=400) recruited from Baltimore City and County neighborhoods new to Mobile SPARC services. Mobile SPARC is an existing low-barrier, outreach program serving other neighborhood and offers harm reduction supplies (i.e., sterile syringes, naloxone, condoms), necessities (i.e., food, clothing), trauma informed micro-counseling, and necessary referrals The study aims to: 1) adapt and expand Mobile SPARC’s services to identify predisposing (i.e., drug use patterns) and enabling (i.e., access to trusted health services) factors that facilitate or hinder utilization of harm reduction services, employing in- depth interviews with WWUD (N=40) and key informant interviews with Mobile SPARC staff (N=5); 2) evaluate the impact of expanding Mobile SPARC on nonfatal overdose and clinical service engagement (including drug treatment) over 18 months among WWUD (N=400) recruited from neighborhoods in which Mobile SPARC will be newly implemented; and 3) to characterize the implementation of Mobile SPARC using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to inform future implementation and scale up. The SHOUT study will make a significant contribution to the literature in evaluating the impact of tailored, low-barrier mobile outreach on overdose among WWUD. The study’s relevance and sustainability will be enhanced through its partnership with SPARC, input from a community advisory board, and support of long- term collaborating organizations and health department stakeholders as well as the cost effectiveness analysis. This proposal is highly responsive to the RFA DA-22-046’s emphasis on replicable harm reduction service delivery model targeting underserved populations at high risk of overdose.