Reduction of Medical Complications associated with Injection Drug Use

描述（由申请人提供）：注射药物使用（IDU）是一个主要的公共卫生问题，与许多医疗并发症相关，包括血源性病毒性疾病（如艾滋病毒、丙型肝炎）和细菌感染（如皮肤脓肿、心内膜炎），这些通常是由高风险药物注射实践引起的。尽管约32%的注射吸毒者报告当前感染，近70%报告终生流行，但目前尚无旨在减少注射吸毒者细菌感染的干预措施。该研究项目的长期目标是通过开发和确立结合心理教育、技能培养和动机访谈的干预措施的有效性，减少导致细菌和病毒感染的活跃注射者的高风险注射行为。在研究的第一阶段，我们将对16名注射吸毒者进行焦点小组访谈，以确定对这一人群进行干预的重点领域。然后，我们将开发一种针对活跃注射吸毒者的感染控制干预措施，在一项公开试验中对5名新参与者进行干预试验，并征求他们对干预措施的反馈。在改进干预措施后，我们将进行一项小型随机对照试验（n = 60，每组30人），以检查与仅评估条件相比干预措施的有效性。我们期望随机参与干预的参与者将改善皮肤和针头清洁行为技能，减少细菌和病毒感染的高风险注射行为。此外，我们将在所有阶段检查干预的可接受性和可行性。这一干预措施将有助于减少注射吸毒者中细菌感染和病毒性疾病的发生，从而改善这一人群的健康结果并降低保健费用。公共卫生相关性：病毒和细菌感染是注射吸毒者的主要问题，并导致昂贵的急诊科使用率、住院率和发病率。这个第一阶段治疗发展项目的目标是开发和测试注射吸毒者皮肤和针头卫生干预的初步可行性、可接受性和有效性。该研究项目的长期目标是开发有效的感染预防项目，该项目结合了信息-动机-行为技能理论模型的组成部分。

DESCRIPTION (provided by applicant): Injection drug use (IDU) is a major public health problem that is associated with a host of medical complications, including blood-borne viral disease (e.g., HIV, Hepatitis C) and bacterial infections (e.g., skin abscesses, endocarditis), that often result from high-risk drug injection practices. There are no current interventions designed to reduce bacterial infections among IDUs, despite approximately 32% of IDUs reporting a current infection and almost 70% reporting a lifetime prevalence. The long-term objective of this program of research is to reduce high-risk injection practices among active IDUs that lead to bacterial and viral infections by developing and establishing the efficacy of an intervention that combines psychoeducation, skill-building, and motivational interviewing. In the first phase of the study, we will conduct focus group interviews with 16 IDUs in order to determine key areas of emphasis for an intervention with this population. We will then develop an infection-control intervention for active IDUs, pilot the intervention with 5 new participants in an open trial, and elicit their feedback regarding the intervention. Following refinement of the intervention, we will conduct a small randomized controlled trial (n = 60; 30 in each arm) to examine the efficacy of the intervention compared to an assessment-only condition. We expect that participants randomized to the intervention will improve skin and needle cleaning behavioral skills and reduce high-risk injection practices for bacterial and viral infections. In addition, we will examine the acceptability and feasibility of the intervention to participants at all phases. This intervention will help to reduce the acquisition of bacterial infections and viral disease among IDUs, thus improving health outcomes for this population and reducing health care costs. PUBLIC HEALTH RELEVANCE: Viral and bacterial infections are a major problem among injection drug users, and contribute to costly emergency department utilization, hospitalization, and morbidity. The goal of this Stage I treatment development project is to develop and test the initial feasibility, acceptability, and efficacy of a skin and needle hygiene intervention for IDUs. The long-term objective of this program of research is to develop effective infection prevention programs that incorporate components of the Information-Motivation-Behavioral Skills theoretical model.