Preventing Injection: An mHealth intervention that leverages social networks to prevent progression to injection among young opioid users

预防注射：一种移动医疗干预措施，利用社交网络来防止年轻阿片类药物使用者发展为注射

• 批准号: 9934514
• 负责人: Michelle C Acosta
• 金额: $ 7.34万
• 依托单位: GRADUATE SCHOOL OF PUBLIC HEALTH AND HEALTH POLICY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9934514
• 关键词: 21 year old; AIDS education; AIDS/HIV problem; Adolescence; American; Automobile Driving; Behavior; Behavior Therapy; Car Phone; Centers for Disease Control and Prevention (U.S.); Cessation of life; Cognitive Therapy; Counseling; Data; Dependence; Development; Diffusion; Drug Use Disorder; Drug usage; Economics; Effectiveness; Epidemic; Face; Feedback; Fibrinogen; Focus Groups; HIV/HCV; Hair; Health; Health Personnel; Hepatitis C Incidence; Heroin; Heroin Users; Homelessness; Improve Access; Incidence; Injections; Integrative Therapy; Intervention; Interview; Measures; Motivation; Naloxone; Opiate Addiction; Opioid; Opioid user; Oral; Outcome; Overdose; Participant; Patient Self-Report; Persons; Pharmaceutical Preparations; Population; Process; Program Development; Psychosocial Factor; Randomized Controlled Trials; Reporting; Research; Research Personnel; Risk; Risk Behaviors; Role; Self Management; Severities; Social Network; Target Populations; Text Messaging; Toxicology; Training; United States Substance Abuse and Mental Health Services Administration; Urine; Vulnerable Populations; Withdrawal; Youth; addiction; cost; critical period; effectiveness trial; evidence base; follow-up; heroin use; high risk; injection drug use; innovation; intervention participants; mHealth; mobile application; novel; opioid injection; opioid use; opioid use disorder; overdose prevention; peer; physical abuse; prescription opioid; prescription opioid misuse; prevent; psychosocial; public health relevance; response; seal; secondary outcome; social; usability; virtual; young adult

Project Summary/Abstract Opioid use disorders (OUD) are the second most common type of drug use disorder in the US, with nearly 2 million Americans with prescription opioid- (PO) and ~570,000 with heroin-related OUD. The escalation in OUD during the past two decades has been most pronounced among youth, many of whom demonstrate a rapid transition from nonmedical PO use (16-17 y/o), to heroin (19-20 y/o), with most progressing to injection drug use (IDU), within a year of starting heroin use (20-21 y/o). Progression to IDU is characterized by uniquely high levels of risk for youth, including higher rates of overdose (OD) and HIV and HCV incidence, compared to older peers. Addiction severity, psychosocial functioning, and social networks are robust predictors of transitioning to IDU; however there is virtually no research on how to prevent or halt this transition to IDU. Given the paucity of interventions targeting this large and vulnerable group of youth, we propose to adapt and evaluate an innovative, engaging mHealth intervention to prevent young opioid users (18-29) from transitioning to IDU. Aim 1: During months 1-12, we will adapt our existing mobile intervention for OUD that includes daily text messages plus key components of evidence-based CBT interventions, including Functional Analysis of Drug Use, Self- Management, and Social / Recreational Counseling. New components specific to youth will focus on the role of peers on opioid use and IDU, and OD prevention / response training. Our iterative development process will include focus groups with opioid-using youth (n=24), interviews with important stakeholders (e.g., youth treatment providers; n=6), and feedback and usability data from opioid-using youth (n=30). Aim 2: During months 13-31, we will conduct a small randomized, controlled trial of the tailored mHealth intervention with young opioid users who have not transitioned to regular injection (n=64) and compare (1) assessment plus in-person OD prevention / response training (including naloxone) versus (2) assessment plus in-person OD prevention / response training (including naloxone) plus our mHealth intervention. Feasibility and acceptability will be assessed via participant feedback, retention, and usage data. Diffusion will be defined as the number of participants' peers who download the intervention app for their own use. Preliminary effectiveness will be measured via reductions in opioid use (TLFB, urine / hair toxicology) and self-reported injection status at 4, 8, and 12 weeks, and 3 and 6 month follow-up. Secondary outcomes include HIV/HCV risk behavior, OD, opioid-related problems (e.g., withdrawal episodes), and social network IDU-related norms and behaviors. If results are promising, this novel intervention will be expanded for examination in a large- scale efficacy / effectiveness trial. This intervention may have tremendous impact on improving access, acceptability, and potency of opioid use interventions for youth. Given the extremely widespread use of mobile apps among young adults (98% of 18-29 y/o own mobile phones and spend ~3 hr/day using mobile apps), evidence-based mHealth interventions may have significant reach for this difficult-to-engage population.

项目概要/摘要 阿片类药物使用障碍 (OUD) 是美国第二大常见的药物使用障碍类型，近 2 百万美国人持有处方阿片类药物 (PO)，约 570,000 名美国人持有海洛因相关 OUD。 OUD升级 在过去的二十年中，这种现象在青年人中最为明显，他们中的许多人表现出快速的 从非医疗 PO 使用（16-17 岁）过渡到海洛因（19-20 岁），其中大多数进展为注射吸毒 (IDU)，开始使用海洛因后一年内（20-21 岁）。进展为 IDU 的特点是具有独特的高水平 与年长同龄人相比，青少年面临的风险更大，包括服药过量 (OD) 率以及艾滋病毒和丙肝病毒发病率更高。 成瘾严重程度、社会心理功能和社交网络是向注射吸毒者过渡的有力预测因素； 然而，实际上没有关于如何预防或阻止向注射吸毒者过渡的研究。鉴于缺乏 针对这一庞大而脆弱的青年群体的干预措施，我们建议调整和评估创新的、 参与移动医疗干预，以防止年轻的阿片类药物使用者（18-29 岁）转向注射吸毒者。目标 1：期间 第 1-12 个月，我们将调整现有的 OUD 移动干预措施，其中包括每日短信 加上基于证据的 CBT 干预措施的关键组成部分，包括药物使用的功能分析、自我 管理和社会/娱乐咨询。针对青年的新组成部分将重点关注 同行了解阿片类药物的使用和注射吸毒者以及吸毒成瘾预防/反应培训。我们的迭代开发过程将 包括与使用阿片类药物的青少年（n = 24）进行焦点小组讨论，与重要利益相关者（例如青少年）进行访谈 治疗提供者； n=6），以及使用阿片类药物的青少年的反馈和可用性数据（n=30）。目标 2：期间 第 13 至 31 个月，我们将针对量身定制的移动医疗干预措施进行小型随机对照试验 与尚未过渡到常规注射的年轻阿片类药物使用者 (n=64) 进行比较 (1) 评估加上现场 OD 预防/反应培训（包括纳洛酮）对比 (2) 评估加上现场 OD 预防/反应培训（包括纳洛酮）加上我们的 mHealth 干涉。将通过参与者的反馈、保留和使用数据来评估可行性和可接受性。 扩散将被定义为为自己下载干预应用程序的参与者同伴的数量 使用。初步有效性将通过阿片类药物使用的减少（TLFB、尿液/头发毒理学）和 第 4、8 和 12 周以及 3 和 6 个月随访时自我报告的注射状态。次要结果包括 HIV/HCV 风险行为、OD、阿片类药物相关问题（例如戒断发作）以及社交网络 IDU 相关 规范和行为。如果结果是有希望的，这种新颖的干预措施将在更大范围内进行扩展以进行检验 规模功效/有效性试验。这种干预可能会对改善可及性产生巨大影响， 青少年阿片类药物使用干预措施的可接受性和效力。鉴于移动设备的广泛使用 年轻人中的应用程序（18-29 岁的人中 98% 拥有手机，并且每天花费约 3 小时使用移动应用程序）， 基于证据的移动医疗干预措施可能会对这一难以参与的人群产生重大影响。