Strategies to reduce serious bacterial infections and overdose among people who inject drugs

项目摘要 严重的细菌感染，包括感染性心内膜炎和皮肤及软组织感染， 注射毒品者最常见的医疗并发症之一（PWID）。住院治疗 2010年至2015年间，注射相关感染性心内膜炎增加了12倍， 皮肤和软组织感染在过去二十年中翻了一番。这些疾病的费用也增加了 戏剧性地。 虽然有正在进行的以医院为基础的计划，以减少注射相关的细菌感染， 长期有效性、成本和成本效益尚不清楚。纵向调查这些 鉴于美国阿片类药物流行的迅速扩大，迫切需要采取干预措施来改善结果， 由于OUD的复发性质，注射阿片类药物的人的异质性， 以及毒品供应的变化模拟建模可以通过预测来增加试验的证据 不同人群在较长时间范围内的临床和经济结果。这项拟议的研究 将使用模拟建模来研究注射阿片类药物使用实践变化的影响， 以医院为基础的干预措施，旨在解决潜在的OUD对注射相关的发病率 细菌感染，具有以下科学目的： 目的1：建立阿片类药物注射使用的模拟模型，以预测长期发病率、结局和 注射相关感染性心内膜炎、皮肤和软组织感染以及用药过量的费用。目标2： 估计医院发起的成瘾护理和快速访问的临床影响，成本和成本效益 与注射类阿片者住院后药物治疗的联系。目标3：执行 综合经济评估以及正在进行的临床试验，并使用模拟模型， 评估以医院为基础的皮肤和针头卫生计划的长期临床效果， 预防注射阿片类药物者的细菌感染。 在K 01项目期间，候选人将在三个主要领域发展特定技能： (1)仿真建模的先进定量方法;（2）理解设计，可操作性， 和评估基于医院的PWID干预措施;（3）测量医疗保健利用和成本- 有效性分析以及临床试验。培训将通过强化组合完成 正规的结构化课程、培训讲习班和实地经验、应用研究经验，以及 在数学建模，生物统计学，成瘾，医院为基础的干预和健康集中辅导 经济学掌握这些技能将使候选人能够实现他的长期目标，即 成为独立资助的研究者和临床决策和卫生政策的全球专家 物质使用和传染病的交叉点。

PROJECT SUMMARY Serious bacterial infections including infective endocarditis and skin and soft tissue infections are among the most common medical complications in persons who inject drugs (PWID). Hospitalizations for injection-related infective endocarditis increased twelve-fold between 2010 and 2015 and for heroin-related skin and soft tissue infections doubled over the last two decades. Costs of these diseases have also increased dramatically. While there are ongoing hospital-based programs to reduce injection-related bacterial infections, their long-term effectiveness, costs, and cost-effectiveness are unknown. Longitudinal investigation of these interventions is urgently needed to improve outcomes given the rapid expansion of the US opioid epidemic, but is challenging due to the relapsing nature of OUD, the heterogeneous nature of persons who inject opioids, and the shifting nature of the drug supply. Simulation modeling can augment evidence from trials by projecting the clinical and economic outcomes over longer time horizons for different populations. This proposed research will use simulation modeling to examine the impact of changes in injection opioid use practices as well as hospital-based interventions aimed at addressing the underlying OUD on the incidence of injection-related bacterial infections with the following scientific aims: Aim 1: To develop a simulation model of injection opioid use to project long-term incidence, outcomes, and costs of injection-related infective endocarditis, skin and soft tissue infections, and overdose. Aim 2: To estimate the clinical impact, costs, and cost-effectiveness of hospital-initiated addiction care and rapid-access linkage to post-hospital medication treatment for persons who inject opioids. Aim 3: To perform a comprehensive economic evaluation alongside an ongoing clinical trial and to use the simulation model to estimate the long-term clinical effectiveness of a hospital-based skin and needle hygiene program aimed to prevent bacterial infections among persons who inject opioids. During the K01 project period, the candidate will develop a specific skill set in three primary domains: (1) advanced quantitative methods for simulation modeling; (2) understanding the design, operationalization, and evaluation of hospital-based interventions for PWID; and (3) measuring healthcare utilization and cost- effectiveness analyses alongside clinical trials. Training will be accomplished through an intensive combination of formal structured courses, training workshops and field experiences, applied research experience, and focused mentorship in mathematical modeling, biostatistics, addiction, hospital-based interventions, and health economics. Acquisition of these skills will allow the candidate to accomplish his long-term goal, which is to become an independently-funded investigator and global expert on clinical decision making and health policy at the intersection of substance use and infectious diseases.