Improving Equitable Access to Naloxone to Prevent Opioid Overdose Deaths Within Syringe Service Programs

改善纳洛酮的公平获取，以防止注射器服务计划中阿片类药物过量死亡

• 批准号: 10371315
• 负责人: Barrot Hopkins Lambdin
• 金额: $ 71.27万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10371315
• 关键词: Address; Affect; Area; Black Populations; Black race; Black, Indigenous, People of Color; California; Caring; Consensus; Country; Data; Dose; Drops; Effectiveness of Interventions; Event; Evidence based intervention; Goals; Health; Indigenous; Injecting drug user; Interruption; Intervention; Latinx; Latinx population; Modification; Naloxone; Needle-Exchange Programs; Opioid Antagonist; Outcome; Overdose; Participant; Penetration; Performance; Periodicity; Persons; Pilot Projects; Population; Principal Investigator; Process; Randomized; Randomized Controlled Trials; Reduce health disparities; Research; Research Personnel; Series; Services; Support System; System; Systems Analysis; Testing; Time; Training; Trust; United States; United States Dept. of Health and Human Services; United States Substance Abuse and Mental Health Services Administration; Work; arm; base; cost; cost effectiveness; cost estimate; cultural competence; design; disparity reduction; effectiveness testing; experience; health care disparity; health care service; health inequalities; implementation strategy; improve minority health; improved; mortality; opioid mortality; opioid overdose; overdose death; people of color; prevent; programs; response; screening; therapy design; treatment as usual

We propose to conduct a randomized controlled trial to test the effectiveness and cost -effectiveness of an intervention designed to increase and improve equitable naloxone distribution in 48 syringe service programs (SSPs) throughout California. In the past 5 years, opioid overdose mortality rates increased 114% among Black, 97% among Latinx, and 32% among White populations. Opioid overdose fatalities are preventable with the timely administration of naloxone, an opioid antagonist, yet our research has shown that Black and Latinx people who inject drugs (PWID) are 25% and 47% less likely, respectively, to receive naloxone than White PWID. Building on pilot work (R21DA046703; Principal Investigator: Lambdin), we will use the Systems Analysis and Improvement Approach to improve equitable access to naloxone from SSPs (SAIA-Naloxone). In our pilot study with two SSPs in California, we found that SAIA-Naloxone led to an average increase of 23 more people receiving naloxone (p<0.001) and 64 more naloxone doses bein g distributed (p<0.001) per week. We observed a 116% increase in naloxone distribution to participants who were Black, Indigenous, or People of Color (BIPOC). SAIA-Naloxone was feasible and acceptable, and it resulted in meaningful improvements in naloxone penetration. We are now proposing to test SAIA-Naloxone in a large-scale randomized controlled trial. To effectively address opioid overdoses, SSP-based naloxone programs must engage participants in a series of sequential steps including screening participants; training them in naloxone administration; distributing naloxone; and building systems that support participants to possess naloxone, use naloxone during overdose events, and obtain naloxone refills as needed. This paradigm is known as the naloxone delivery cascade. SAIA-Naloxone is a multicomponent implementation strategy designed to help SSPs identify and address weaknesses along the naloxone delivery cascade. It includes determination of drop-offs in cascade delivery, process mapping and consensus discussions to identify potential solutions, and continuous quality improvement. Our Aim 1 is to test the effectiveness of SAIA-Naloxone on improving naloxone distribution at SSPs, relative to treatment as usual. Aim 2 is to test the effectiveness of SAIA-Naloxone on improving naloxone distribution at SSPs to BIPOC participants, relative to treatment as usual. Aim 3 is to estimate the cost and cost-effectiveness of SAIA-Naloxone on improving equitable access to naloxone at syringe service programs, relative to treatment as usual. This project will directly contribute to the improvement of minority health and the reduction of health disparities. The proposed study aligns with the goals of the Department of Health and Human Services and the Substance Abuse and Mental Health Services Administration, which recognize naloxone access as our nation’s first defense to prevent opioid overdose deaths.

我们建议进行一项随机对照试验，以测试 干预措施旨在增加和改善48个注射器服务计划中的公平纳洛酮分布 （SSP）整个加利福尼亚。在过去的5年中，阿片类药物过量死亡率在 黑色，在拉丁裔中为97％，白人人群中有32％。阿片类药物过量死亡是可以预防的 阿片类药物拮抗剂纳洛酮的及时给药，但我们的研究表明，黑人和拉丁裔 注射毒品（PWID）的人分别比白色的纳洛酮分别低25％和47％ PWID。在试点工作的基础上（R21DA046703；首席研究员：Lambdin），我们将使用系统 分析和改进方法可以改善从SSP（SAIA-NALOXONE）获得纳洛酮的公平访问。在 我们在加利福尼亚州的两个SSP进行的试点研究，我们发现Saia-Naloxone的平均平均增加为23 每周收到纳洛酮（p <0.001）的人（p <0.001）和64个纳洛酮剂量分布（p <0.001）。 我们观察到对黑人，土著或人的参与者的纳洛酮分布增加了116％ 颜色（BIPOC）。 SAIA-NANOXONE是可行和可接受的，这导致了有意义的改进 纳洛酮穿透。我们现在建议在大规模随机控制 审判。为了有效解决阿片类药物过量，基于SSP的纳洛酮计划必须参与参与者 一系列顺序步骤，包括筛选参与者；在纳洛酮给药中培训他们； 分发纳洛酮；以及支持参与者拥有纳洛酮的建筑系统，在期间使用纳洛酮 过量的事件，并根据需要获得纳洛酮补充。该范式被称为纳洛酮传递 级联。 SAIA-NANOXONE是一种多组分实施策略，旨在帮助SSP识别和 解决纳洛酮输送级联的弱点。它包括确定级联的下降 交付，过程映射和共识讨论以识别潜在的解决方案和持续质量 改进。我们的目标1是测试Saia-Naloxone对改善纳洛酮分布的有效性 SSP，相对于往常而言。 AIM 2是测试Saia-Naloxone对改进的有效性 与往常一样，SSP的纳洛酮分布向BIPOC参与者。目标3是估计 Saia-Naloxone的成本和成本效益，以改善注射器服务的naloxone的公平访问 程序，相对于往常而言。该项目将直接有助于改善少数民族 健康与健康差异的降低。拟议的研究与部门的目标保持一致 卫生与公共服务以及滥用药物和心理健康服务管理局， 承认纳洛酮是我们国家的第一个防止阿片类药物过量死亡的辩护。