Retention and Re-Engagement in Treatment for Addiction following Serious Injection Related Infections (RETAIN)

严重注射相关感染后保留和重新参与成瘾治疗（RETAIN）

• 批准号: 10282857
• 负责人: Simeon Kimmel
• 金额: $ 18.94万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-15 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10282857
• 关键词: Acute suppurative arthritis due to bacteria; Address; Advisory Committees; Antibiotics; Area; Bacteremia; Biometry; Boston; Buprenorphine; Caring; Cessation of life; Clinical Trials; Clinical Trials Design; Communicable Diseases; Complex; Continuity of Patient Care; Data; Data Set; Development; Drug usage; Endocarditis; Enrollment; Epidural Abscess; Event; Evidence based intervention; Face; Future; Goals; Health care facility; Healthcare Systems; Home; Hospitalization; Hospitals; Imprisonment; Individual; Infection; Infective endocarditis; Injectable; Injections; Inpatients; Intervention; Interview; Intravenous; K-Series Research Career Programs; Lead; Link; Massachusetts; Medical; Medical center; Medicine; Mentorship; Methadone; Modeling; Morbidity - disease rate; Naltrexone; National Institute of Drug Abuse; Osteomyelitis; Outpatients; Overdose; Participant; Population; Positioning Attribute; Primary Health Care; Public Health; Qualitative Methods; Randomized Controlled Trials; Records; Recovery; Recurrence; Research; Research Personnel; Research Training; Specialist; Structure; Testing; Work; acceptability and feasibility; acute care; addiction; base; care outcomes; career; checkup examination; cost; design; effectiveness trial; evidence base; experience; high risk; hospital readmission; improved; insight; large datasets; mortality; motivational enhancement therapy; novel; opioid epidemic; opioid injection; opioid overdose; opioid use; opioid use disorder; outreach; peer; prescription opioid; prevent; programs; randomized trial; response; skills; substance use treatment; success; therapy development; trial design

PROJECT SUMMARY Serious injection-related infections (SIRIs), including infective endocarditis, bacteremia, osteomyelitis, epidural abscess, and septic arthritis have more than doubled since 2002 due to the opioid epidemic, causing morbidity, mortality, and costing more than $700 million annually. Growing evidence suggests that medications for opioid use disorder (MOUD) which include methadone, buprenorphine, and extended-release naltrexone reduce readmission and death following SIRIs. In response to this emerging data, programs and studies seek to optimize MOUD initiation in hospitals. However, the benefits of MOUD have not been fully realized due to limited retention in treatment with MOUD after hospitalization. To date, there has been a paucity of research focused on MOUD retention, the crucial next step of the opioid use disorder (OUD) care continuum. Further, evidence-based MOUD retention interventions have not been adapted for individuals with SIRIs who have riskier injection practices, greater medical complexity, mortality, and costs than others with OUD. The Recovery Management Checkups model is a proactive, peer-delivered, motivational interviewing-based MOUD retention intervention that increased retention by 50% in outpatient addition treatment and following incarceration. It has been piloted in multiple settings, making it a promising intervention for individuals with SIRIs who face unique challenges following their infections. Therefore, the central objective of this proposal is to determine individual and group factors associated with MOUD treatment along the OUD care continuum in the critical 12 month period after a SIRI and to use these insights to adapt and test Recovery Management Checkups for this new population. This proposal includes three aims: 1) Examine MOUD treatment along the OUD care continuum in the 12 months after SIRIs; 2) Informed by the findings from Aim 1, adapt the Recovery Management Checkups MOUD retention model for individuals with SIRIs; 3) Conduct a pilot randomized controlled trial of the adapted intervention to promote MOUD retention and re-engagement for individuals with SIRIs. The findings from these Aims address a gap in current research and will inform care for individuals with SIRIs, a priority area for the National Institute on Drug Abuse. Dr. Kimmel, an early-career investigator is the PI and will use this Career Development Award to develop skills in modeling approaches to address recurrent events (e.g. multiple treatment episodes) and group membership (e.g. latent classes) in treatment retention data, qualitative methods, intervention adaptation and development, and clinical trials design. Developing these skills will position him to lead impactful research that will improve the care and outcomes for very high- risk individuals who use drugs. Dr. Kimmel will work closely with a mentorship and advisory team with experience in addiction medicine, infectious diseases, biostatistics, qualitative methods, intervention adaptation and development and clinical trials to accomplish his research and training Aims.

项目摘要 严重注射相关的感染（SIRIS），包括感染性心内膜炎，菌血症，骨髓炎，硬膜外麻醉 自2002年以来，由于阿片类药物流行，脓肿和败血性关节炎已增加了一倍以上，导致发病率 死亡率，每年耗资超过7亿美元。越来越多的证据表明阿片类药物的药物 使用障碍（MOUD），包括美沙酮，丁丙诺啡和延长释放纳曲酮减少 Siris之后的再入院和死亡。为了回应这些新兴数据，计划和研究试图 优化医院中的MOUD启动。但是，由于 住院后用MOUD治疗的保留有限。迄今为止，研究已经很少 专注于穆德保留率，这是阿片类药物使用障碍（OUD）护理连续体的关键下一步。更远， 基于证据的MOUD保留干预措施尚未适用于具有Siris的人 与其他人相比，风险更大的注射习惯，更大的医疗复杂性，死亡率和成本。这 恢复管理检查模型是一种积极主动的，同行的，基于访谈的穆德 保留干预措施，将保留率提高50％，以便在门诊添加治疗和以下 监禁。它已经在多种环境中进行了驾驶，使其成为有希望的人 在感染后面临独特挑战的西里斯。因此，该提议的核心目标是 确定沿Oud Care Contunuum中的MOUD治疗相关的个人和团体因素 Siri之后的关键12个月，并使用这些见解来适应和测试恢复管理 检查这个新人群。该建议包括三个目的：1）检查沿 在Siris后的12个月内，Oud Care Continuum； 2）在AIM 1的调查结果中告知，调整恢复 管理人员检查Siris个人的MOUD保留模型； 3）进行随机的飞行员 适应的干预措施的对照试验，以促进患有穆德的保留和重新参与 西里斯。这些目的的发现解决了当前研究的差距，并将为患有 Siris，美国国家药物滥用研究所的优先领域。早期研究员Kimmel博士是PI 并将使用该职业发展奖来开发建模方法以解决经常性的方法 事件（例如多次治疗事件）和小组成员资格（例如潜在类别）在治疗保留中 数据，定性方法，干预适应和开发以及临床试验设计。发展 这些技能将使他领导有影响力的研究，以改善非常高的护理和成果 风险使用毒品的人。 Kimmel博士将与一个指导和咨询团队紧密合作 成瘾医学，传染病，生物统计学，定性方法，干预适应经验 以及开发和临床试验，以实现他的研究和培训目的。