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

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推动的 主要是合成阿片类药物(即芬太尼和芬太尼类似物)和与兴奋剂有关的死亡增加。我们 记录了#年吸毒妇女(WWUD)(N=385)经历的这一流行病的严重程度 巴尔的摩市报告了服药过量的高比率(28%)，目睹了致命的服药过量(35%)， 在过去的6个月中发现了非致命性的过量用药(52%)。我们还记录了一些 结构性脆弱性(如无家可归、饥饿)、精神疾病(如创伤后应激障碍、抑郁症)、 人际暴力和混乱的药物使用模式(即多物质使用)，间接和直接推动 妇女服药过量和其他疾病(如艾滋病毒、丙型肝炎)的明显风险。然而，WWUD经历了无数 接受必要的医疗和行为服务的障碍，这些服务可以降低他们服药过量的风险 其他危害，新冠肺炎疫情放大了障碍。我们建议进行这场呐喊 (持续减少伤害外展)研究，第一类混合有效性-实施设计，以评估 以WWUD为中心的流动减害服务对非致命性过量用药的影响和实施 从巴尔的摩市和县社区招募的WWUD(N=400)的临床护理参与度 移动SPARC服务的新手。Mobile SPARC是一个现有的低门槛外展计划，服务于其他 社区并提供减少伤害的用品(即无菌注射器、纳洛酮、避孕套)、必需品(即， 食物，衣物)，创伤知情的微咨询，和必要的转介本研究的目的是：1)适应和 扩展Mobile SPARC的服务以识别诱因(即，吸毒模式)和启用(即，访问 受信任的健康服务)促进或阻碍使用减少危害服务的因素，利用- 与WWUD的深度访谈(N=40)和与流动SPARC工作人员的关键线人访谈(N=5)；2)评估 扩大流动SPARC对非致命性过量用药和临床服务参与度(包括药品)的影响 治疗)从Mobile SPARC将在哪些社区招募的WWUD(N=400)中超过18个月 将被新实施；以及3)描述使用REACH的移动SPARC实施的特征， 有效性、采用、实施、维护(RE-AIM)框架，为未来的实施提供信息 并扩大规模。Shout研究将对文献评估的影响做出重大贡献 针对WWUD中过量用药的量身定做、低障碍的流动宣传。这项研究的相关性和可持续性将 通过与SPARC的伙伴关系、社区咨询委员会的投入以及对长期-- 长期合作组织和卫生部门利益相关者以及成本效益 分析。该提案高度响应了RFA DA-22-046‘S对减少可复制危害的强调 以服药过量风险较高的服务不足人群为目标的服务提供模式。

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.