Perinatal care as a venue to reduce opioid overdoses and hepatitis C virus incidence (PreVenT OD HCV)

围产期护理是减少阿片类药物过量和丙型肝炎病毒发病率 (PreVenT OD HCV) 的场所

• 批准号: 10620846
• 负责人: Rachel Lee Epstein
• 金额: $ 17.54万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10620846
• 关键词: Address; Adult; Age; Age Reporting; Award; Calibration; Caring; Child; Childhood; Clinic; Clinical; Clinical effectiveness; Communicable Diseases; Cost Analysis; Cost effectiveness research; Data; Decision Modeling; Diagnosis; Discipline of obstetrics; Epidemic; Family; Future; Goals; HIV; Health; Healthcare; Hepatitis C; Hepatitis C Incidence; Hepatitis C Therapy; Hepatitis C Transmission; Hepatitis C virus; Hospitalization; Human; Infant; Infection; Inpatients; Intervention; K-Series Research Career Programs; Learning; Link; Maternal Mortality; Measures; Medicine; Mentors; Methods; Modeling; National Institute of Drug Abuse; Opioid; Outcome; Overdose; Overdose reduction; Perinatal; Perinatal Care; Persons; Pharmaceutical Preparations; Physicians; Policies; Population; Population Decreases; Postpartum Period; Predisposition; Pregnancy; Pregnant Women; Prevalence; Public Health; Publishing; Quality-Adjusted Life Years; Recovery; Research; Research Personnel; Resource Allocation; Resources; Risk Factors; Role; Sampling; Science; Seroprevalences; Services; Techniques; Testing; Time; Training; United States; United States National Institutes of Health; Visit; Woman; Work; Youth; addiction; care costs; care delivery; care seeking; career; career development; clinical effect; comparative cost effectiveness; cost; cost effective; cost effectiveness; design; disease transmission; economic evaluation; efficacy evaluation; epidemic virus; experience; health care service utilization; health data; health economics; health service use; improved; injection drug use; innovation; medication for opioid use disorder; microcosting; models and simulation; mortality; opioid epidemic; opioid misuse; opioid mortality; opioid overdose; opioid use disorder; overdose death; perinatal health; perinatal period; post pregnancy; pregnancy associated death; prenatal; prevent; programs; reproductive; retention rate; skills; substance use; transmission process; young woman

PROJECT SUMMARY/ABSTRACT Amidst the current opioid overdose crisis, 1.4 million women of reproductive age report non-medical opioid use, and opioid use disorder (OUD) prevalence among pregnant women rose five-fold from 1998-2017. Although pregnancy may be a motivating time to start medications to treat OUD, retention post-partum declines significantly and is associated with unacceptably high opioid overdose and mortality rates. Injection drug use is also the primary risk factor for hepatitis C virus (HCV) infection in the United States (U.S.). Women now comprise nearly half of new HCV infections, and HCV seroprevalence has also risen five-fold in pregnant women since 2000. Although the U.S. is committed to eliminating HCV, about 50% of people are unaware of their infection and fewer than 40% of those diagnosed have been treated. Research is needed to identify venues to increase efforts to improve OUD treatment and retention and to identify and treat current HCV infection. Perinatal care provides longitudinal access to women over a nearly one-year period, and as pregnancy may be a motivating time for women to seek care for both OUD and HCV, perinatal care may be a critical venue to reach women who inject drugs, a key population that NIDA identifies as central to the ongoing opioid crisis. Yet, little data exist to measure the role of the perinatal care venue to reach national OUD and HCV treatment goals. This study aims to create a perinatal-specific decision model and measure health service utilization and costs of a perinatal OUD and HCV intervention to identify how to leverage the perinatal care venue to decrease postpartum opioid overdoses and population-level HCV transmission. This study has two main aims: (1) to build a microsimulation model to analyze the clinical and health economic effects of leveraging the perinatal care venue to reduce opioid overdoses and population-level and infant HCV transmission; (2) to measure health services utilization and costs of incorporating MOUD and HCV treatment into perinatal care. The results of this study could help determine most efficient resource allocation to achieve national overdose and HCV elimination goals. The PI, Dr. Epstein, is an early career investigator, trained in pediatric and adult infectious diseases, with a focus on addiction medicine and HCV in pregnant women and youth. This career development award will allow her to gain expertise in 1) transmission modeling and model calibration and 2) health economic evaluation and micro-costing to be able to conduct comparative cost-effectiveness research to inform interventions for women with substance use and HCV. She has compiled an experienced team of mentors and advisors to help her achieve her training and career goals, to become an independent clinician-investigator expert in utilizing decision science to project most effective use of resources to improve care for families at the center of the opioid overdose, HCV and HIV epidemics.

项目总结/摘要 在目前的阿片类药物过量危机中，140万育龄妇女报告非医疗阿片类药物 从1998年到2017年，孕妇中阿片类药物使用障碍（OUD）的患病率上升了五倍。 虽然怀孕可能是一个动机时间开始药物治疗OUD，保留产后 显著下降，并与不可接受的高阿片类药物过量和死亡率有关。注射 在美国，药物使用也是丙型肝炎病毒（HCV）感染的主要危险因素。妇女 现在占新发HCV感染的近一半，在孕妇中HCV血清阳性率也上升了五倍。 自2000年以来，女性。尽管美国致力于消除HCV，但约50%的人不知道 只有不到40%的确诊患者得到了治疗。需要进行研究以确定 场馆加大力度，改善OUD治疗和保留，并确定和治疗目前的 HCV感染。围产期护理为妇女提供了近一年的纵向服务， 由于怀孕可能是妇女寻求OUD和HCV护理的动机时间，围产期 护理可能是接触注射毒品的妇女的一个关键场所，NIDA认为这是一个关键人群， 阿片类药物危机的核心然而，几乎没有数据可以衡量围产期护理场所的作用， 达到国家OUD和HCV治疗目标。本研究旨在建立一个围产期特定的决策模型 并测量围产期OUD和HCV干预的卫生服务利用率和成本，以确定如何 利用围产期护理场所减少产后阿片类药物过量和人群水平的HCV 传输本研究主要有两个目的：（1）建立一个微观模拟模型，分析临床和 利用围产期护理场所减少阿片类药物过量和人口水平的卫生经济学影响 和婴儿HCV传播;（2）测量卫生服务利用和纳入MOUD的成本， HCV治疗纳入围产期护理。这项研究的结果可以帮助确定最有效的资源 分配，以实现国家过量和HCV消除目标。私家侦探爱泼斯坦博士是一个早期的职业 研究人员，在儿科和成人传染病培训，重点是成瘾药物和HCV在 孕妇和年轻人。这个职业发展奖将使她获得传播方面的专业知识 建模和模型校准和2）卫生经济学评价和微观成本能够进行 进行比较成本效益研究，为吸毒妇女和丙肝患者的干预措施提供信息。她 已经组建了一支经验丰富的导师和顾问团队，帮助她实现培训和职业目标， 成为一名独立的临床研究专家，利用决策科学进行最有效的项目 利用资源改善对处于阿片类药物过量、HCV和HIV流行中心的家庭的护理。