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

实施和评估新型移动减害服务对吸毒女性过量用药的影响：SHOUT 研究。

• 批准号: 10590364
• 负责人: Susan G. Sherman
• 金额: $ 228.96万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2025-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10590364
• 关键词: AIDS prevention; Abate; Acute; Address; Adoption; American; Area; Back; Baltimore; Behavioral; Behavioral Model; Buprenorphine; COVID-19; COVID-19 pandemic; Case Management; Cessation of life; Cities; Client; Clinical Services; Clothing; Communities; Cost Effectiveness Analysis; Counseling; County; Drops; Drug usage; Drug user; Educational workshop; Effectiveness; Emergency Situation; Environment; Epidemic; Fentanyl; Food; Future; Grant; HIV; HIV/STD; Hand; Harm Reduction; Health; Health Priorities; Health Services; Health Services Accessibility; Hepatitis C virus; High Risk Woman; Homelessness; Hunger; Impact evaluation; Individual; Interpersonal Violence; Intervention; Interview; Legal; Letters; Literature; Maintenance; Maryland; Measures; Medical; Mental Depression; Mental Health; Modeling; Morbidity - disease rate; Naloxone; Neighborhoods; Outcome Study; Overdose; Pattern; Pharmaceutical Preparations; Pharmacotherapy; Phase; Population; Post-Traumatic Stress Disorders; Primary Health Care; Process; Reach Effectiveness Adoption Implementation and Maintenance; Reporting; Research; Research Personnel; Respondent; Risk; Sampling; Service delivery model; Services; Shelter facility; Site; Social Work; Sterility; Stimulant; Syringes; Testing; Trauma; Trust; Underserved Population; Visit; Vulnerable Populations; Woman; Work; analog; arm; barrier to care; base; clinical care; clinically relevant; condoms; cost effectiveness; drug market; effectiveness implementation design; effectiveness implementation study; experience; future implementation; gender-based violence; health care availability; high risk; implementation determinants; implementation outcomes; improved; informant; innovation; mHealth; medically necessary care; meetings; multidisciplinary; novel; outreach; outreach program; overdose death; overdose risk; pandemic disease; polysubstance use; prevention service; primary outcome; recruit; scaffold; scale up; service delivery; service engagement; service providers; sex; social; success; synthetic opioid

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.

项目摘要 2020年，近92,000名美国人死于药物过量，主要是由致命的毒品供应驱动 由合成阿片类药物（即芬太尼和芬太尼类似物）和刺激性相关的死亡增加。我们 已经记录了使用药物的女性（WWUD）（n = 385）所经历的这种流行的大小 巴尔的摩市报告说，过量服用过量（28％），目睹了致命的过量（35％）， 并在过去6个月中目睹非致命的过量（52％）。我们还记录了许多 结构性脆弱性（即无家可归，饥饿），心理健康病态（即PTSD，抑郁）， 人际关系暴力和混乱的药物使用模式（即，使用多刺激性）间接直接驾驶 妇女出现过量和其他病因的独特风险（即艾滋病毒，HCV）。 wwud经历了无数次 接受必要的医疗和行为服务的障碍，可以降低其过量的风险和 其他危害，障碍物被19009大流行所扩大。我们建议进行喊叫 （持续危害减少外展）研究，一种1型混合有效性 - 实现设计 以WWUD为中心的，减少移动伤害服务的影响和实施对非致命过量和 从巴尔的摩市和县社区招募的WWUD（n = 400）之间的临床护理参与 移动SPARC服务的新手。 Mobile Sparc是现有的低障碍，外展计划，为其他服务服务 邻里并提供减少危害的供应（即无菌注射器，纳洛酮，避孕套），需要 食物，衣服），创伤知情的微库和必要的推荐研究目的是：1）适应和适应 扩展移动SPARC的服务，以识别诱人的（即吸毒模式）并启用（即访问 值得信赖的卫生服务）促进或阻碍减少危害服务的因素 WWUD（n = 40）的深度访谈和与移动SPARC员工的主要线人访谈（n = 5）； 2）评估 扩大移动SPARC对非致命过量和临床服务参与的影响（包括药物 治疗）在WWUD（n = 400）的18个月中，从移动SPARC的社区招募 新实施； 3）要使用覆盖范围来表征移动SPARC的实现， 有效，采用，实施，维护（RE-AIM）框架，以告知未来实施 并扩展。喊叫研究将为文献做出重大贡献，以评估 量身定制的，低障碍的移动外展，对WWUD中的过量服用过量。该研究的相关性和可持续性将 通过与SPARC的合作，社区顾问委员会的意见以及长期支持的支持，可以增强 定期合作组织和卫生部门利益相关者以及成本效益 分析。该提议对RFA DA-22-046的重视对减少危害的重视非常有反应 服务交付模型针对服务不足的人群高风险过量。