Prescription opioid use, misuse, disorders and HIV outcomes

处方阿片类药物的使用、滥用、疾病和艾滋病毒结果

基本信息

批准号：
8993256
负责人：
Joanna L. Starrels
金额：
$ 58.07万
依托单位：
ALBERT EINSTEIN COLLEGE OF MEDICINE, INC
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-09-15 至 2019-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8993256
关键词：
Address Adherence Affect Alcohol or Other Drugs use Area Belief CD4 Lymphocyte Count Caring Characteristics Chronic Clinical Clinical Management Complex Data Degenerative polyarthritis Diagnostic and Statistical Manual of Mental Disorders Disease Dose Drug abuse Drug usage Emergency department visit Epidemic Equation Future Goals Guidelines HIV Health Heterogeneity Hospitalization Human immunodeficiency virus test Illicit Drugs Injury Intervention Interview Longitudinal Studies Low Back Pain Measures Medical Records Medical center Mental Health Mental disorders Modeling Monitor Morphine Neuropathy Observational Study Opioid Outcome Overdose Pain Pain management Pathway interactions Patients Pharmaceutical Preparations Physical Function Population Prevention Provider Reporting Research Risk Role Route Testing Time Toxicology Typology United States United States National Institutes of Health Urine Viral Load result addiction antiretroviral therapy base chronic pain clinical care clinical practice cohort design disability effective intervention evidence base follow-up high risk improved innovation medical specialties novel strategies opioid misuse pill prescription opioid prescription opioid misuse primary outcome prospective psychosocial secondary outcome therapy adherence

项目摘要

DESCRIPTION (provided by applicant): Prescription opioid (PO) use, misuse, disorders, and overdose have dramatically increased. Much of this increase is attributed to providers prescribing POs for chronic pain. Compared to HIV- patients, HIV+ patients are particularly at risk because they suffer disproportionately from chronic pain, have greater PO use and higher PO dose, and often have substance use and mental health disorders that increase the risk for PO misuse. Despite high PO use and risk among HIV+ patients, little is known about the relationship between PO use and HIV outcomes. It is possible that some types of PO use ("PO use conditions") are associated with poor HIV outcomes, similar to illicit drug use. It is also possible that some PO use conditions are not, for example, PO use without misuse could improve patients' pain, physical function, and retention in HIV care. Very few studies have examined PO use and HIV outcomes, and further, it is unknown how patients' psychosocial functioning, pain/disability, and biomedical factors, as well as provider factors (e.g., opioid prescribing practices) influence the relationships between PO use and HIV outcomes. A lack of evidence exists to guide clinical practice or to develop guidelines or effective interventions. Our overarching goal is to advance the evidence base necessary to guide clinical management of HIV+ patients with chronic pain. Among HIV+ patients with chronic pain (low back pain, osteoarthritis, or neuropathy) receiving care in a large urban medical center, we will examine PO use using three distinct constructs: 1) an ordinal PO use condition based on a pain management framework; 2) continuous PO use conditions of PO dose, misuse, and addiction; and 3) typologies of PO use which we will identify using latent class analysis of PO use characteristics. The specific aims are: 1) to characterize PO use in a cohort of HIV+ patients with chronic pain; 2) to examine the association between PO use conditions and HIV outcomes; and 3) to examine the roles of patient and provider factors in the relationship between PO use conditions and HIV outcomes using structural equation modeling. We hypothesize that: a) a higher value on the ordinal PO use scale will be associated with poor HIV outcomes; b) higher values in the continuous PO use conditions (PO dose, opioid misuse, and addiction) will be associated with poor HIV outcomes; c) distinct typologies of PO use will differ in their association with HIV outcomes; and d) patient and provider factors influence PO use conditions, HIV outcomes, and the relationship between PO use conditions and HIV outcomes. Using a longitudinal cohort design with 12-month follow-up, we will conduct interviews, physical function assessments, urine toxicology tests, HIV viral load (VL) tests, and extract medical record data among 250 HIV+ patients with chronic pain. The primary HIV outcome is VL; secondary outcomes are CD4 count, ART utilization and adherence, and retention in care. Study findings will substantially advance this nascent and critical area of research, provide much needed evidence to guide clinical practice, and identify targets for interventions to improve outcomes in HIV+ patients with chronic pain.

描述（由适用提供）：处方使用（PO）使用，MISSUSE，疾病和用药过量已大大增加。这种增加的大部分归因于提供者为慢性疼痛的POS开出POS。与HIV患者相比，HIV+患者尤其处于危险之中，因为他们因慢性疼痛而遭受的痛苦不成比例，使用了更大的PO和PO剂量，并且经常患有吸毒和心理健康障碍，从而增加了PO MISSUSE的风险。尽管艾滋病毒+患者的PO使用量很高和风险，但对PO使用和HIV结局之间的关系知之甚少。某些类型的PO使用（“ PO使用条件”）可能与艾滋病毒不良结局相关，类似于非法吸毒。例如，某些PO使用条件也不是没有小姐的PO使用可以改善患者的疼痛，身体机能和在艾滋病毒护理中的保留。很少有研究检查了PO的使用和HIV结果，此外，尚不清楚患者的社会心理功能，疼痛/残疾和生物医学因素以及提供者因素（例如阿片类药物处方实践）影响PO使用和HIV的关系之间的关系。缺乏证据来指导临床实践或制定指南或有效的干预措施。我们的总体目标是促进指导慢性疼痛的HIV+患者临床管理所需的证据基础。在患有慢性疼痛（下腰痛，骨关节炎或神经病）的HIV+患者中，我们将在大型城市医疗中心接受护理，我们将使用三种不同的构造检查PO使用：1）基于疼痛管理框架的序数PO使用状况； 2）连续使用PO剂量，滥用和成瘾的条件； 3）PO使用的类型，我们将使用PO使用特征的潜在类别分析来识别。具体目的是：1）表征PO在患有慢性疼痛的HIV+患者中的PO使用； 2）检查PO使用条件与HIV结果之间的关联； 3）检查使用结构当量建模的患者和提供者因素在PO使用条件和HIV结果之间的关系中的作用。我们假设：a）较高的序数PO使用量表的价值将与较差的HIV结局有关； b）在连续的PO使用条件（PO剂量，阿片类药物和成瘾）中，较高的值将与较差的HIV结局有关； c）PO使用的不同类型学与HIV结局的关联会有所不同； D）患者和提供者因素影响PO使用条件，HIV结果以及PO使用条件与HIV结果之间的关系。使用具有12个月随访的纵向队列设计，我们将进行访谈，身体功能评估，尿液毒理学测试，HIV病毒载荷（VL）测试以及在250名HIV+患有慢性疼痛的患者中提取病历数据。主要的HIV结果是VL；次要结果是CD4计数，艺术利用和依从性以及保留率。研究发现将大大推动这一新生和关键的研究领域，提供急需的证据来指导临床实践，并确定干预措施的目标，以改善慢性疼痛的HIV+患者的预后。