Assessing the Reach, Effectiveness, and Implementation of Multiple Harm Reduction Interventions.

项目总结/摘要 我们建议评估的范围，有效性，采用，实施和维护（RE-AIM） 旨在改善注射或吸烟者健康的现有和新出现的减少危害服务 加州旧金山弗朗西斯科的非法毒品。与注射或吸烟有关的主要健康并发症 海洛因、芬太尼类似物、甲基苯丙胺和可卡因包括过量和病毒（例如，艾滋病毒、肝炎） 和细菌感染（例如，皮肤和软组织感染和心内膜炎）。发病率急剧上升 与吸毒有关的死亡率促使社区组织的人们 构思和实施创新的减少危害干预措施，以阻止这些卫生紧急情况。 艾滋病毒的迅速蔓延在20世纪80年代末催生了注射器服务计划（SSP）。阿片类药物上升 在20世纪90年代后期，过量死亡引发了过量教育和纳洛酮分布（OEND）。的 芬太尼类似物最近在非法药物市场上的出现产生了芬太尼测试条（FTS）， 基于社区的傅里叶变换红外光谱药物检查（FTIR）和安全消费场所 （SCS）。现在，甲基苯丙胺的重新出现催生了一个甲基苯丙胺清醒中心 2022年在旧金山弗朗西斯科开幕鉴于减少危害服务的实施在2010年和2011年期间是交错的， 在过去35年中，每个国家的证据基础状况各不相同。RE-AIM实施科学 框架通过考虑其覆盖范围、有效性、采用、实施和 上维护我们的目标如下：目标1：评估与公平竞争有关的变化和因素 为弗朗西斯科注射或吸食非法药物的人提供一系列减少伤害的服务 随着时间的推移（到达）。目标2：确定现有和新出现的减少危害服务在以下方面的有效性： 减少旧金山弗朗西斯科注射或吸食非法药物者中与毒品有关的伤害（有效性）。 目标3：探索社区内减少危害服务的采用、实施和维护- 随着时间的推移（采用、实施和维护）。为了实现目标1和2，我们 将招募使用药物的人（PWUD）使用有针对性的抽样进入一个系列的横断面研究。在 每4年，将招募一个新的PWUD样本（n=800），并进行调查，以确定是否可以获得 利用各种现有的和新出现的减少危害干预措施和与毒品有关的危害。为了实现目标3， 我们将在所有社区为基础的工作人员（每年n=30）进行一系列横断面定性研究 在旧金山弗朗西斯科提供减少伤害服务的组织（目前n=10），以评估收养， 实施和维护。我们拟议的研究将提供关于获得、执行、 旨在减少毒品相关危害的新出现和不断演变的减少危害干预措施的影响， 从而帮助美国政策制定者和服务提供商将有效的服务沿着连续体， 规模化实施和维护。

PROJECT SUMMARY/ABSTRACT We propose to assess the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) of existing and emerging harm reduction services designed to improve the health of people who inject or smoke illicit drugs in San Francisco, California. The major health complications associated with injecting or smoking heroin, fentanyl analogs, methamphetamine, and cocaine include overdoses and viral (e.g., HIV, hepatitis) and bacterial infections (e.g., skin and soft tissue infection and endocarditis). Steep increases in morbidity and mortality associated with drug use have motivated people in community-based organizations to conceptualize and implement innovative harm reduction interventions to thwart these health emergencies. The burgeoning HIV epidemic spawned syringe service programs (SSPs) in the late 1980s. Rising opioid overdose mortality spawned overdose education and naloxone distribution (OEND) in the late 1990s. The recent emergence of fentanyl analogs in the illicit drug market spawned fentanyl test strips (FTS), community-based Fourier-transform infrared spectroscopy drug checking (FTIR), and safe consumption sites (SCS). Now, the re-emergence of methamphetamine has spawned a methamphetamine sobering center opening in San Francisco in 2022. Given the staggered implementation of harm reduction services over the past 35 years, the state of the evidence base varies for each. The RE-AIM implementation science framework helps guide evaluations by considering their Reach, Effectiveness, Adoption, Implementation, and Maintenance. Our aims are as follows: Aim 1: Assess changes in and factors associated with equitable access to an array of harm reduction services for people who inject or smoke illicit drugs in San Francisco over time (Reach). Aim 2: Determine the effectiveness of existing and emerging harm reduction services in reducing drug-related harm among people who inject or smoke illicit drugs in San Francisco (Effectiveness). Aim 3: Explore Adoption, Implementation, and Maintenance of harm reduction services within community- based organizations over time (Adoption, Implementation, and Maintenance). To achieve Aims 1 and 2, we will recruit people who use drugs (PWUD) using targeted sampling into a serial cross-sectional study. In each of 4 years, a new sample (n=800) of PWUD will be recruited and surveys will ascertain access to and use of various existing and emerging harm reduction interventions and drug-related harm. To achieve Aim 3, we will conduct a serial cross-sectional qualitative study of staff (n=30 annually) at all community-based organizations that provide harm reduction services in San Francisco (currently n=10) to assess Adoption, Implementation, and Maintenance. Our proposed study will provide data on access to, implementation of, and impact of emerging and evolving harm reduction interventions designed to reduce drug-related harm, thereby helping US policymakers and service providers move effective services along the continuum toward scaled implementation and maintenance.