Evaluation of a community-based education, navigation, and support (CENS) intervention to reduce opioid-related harms among military veterans

对基于社区的教育、导航和支持 (CENS) 干预措施的评估，以减少退伍军人中与阿片类药物相关的伤害

• 批准号: 10298478
• 负责人: Alexander S Bennett
• 金额: $ 71.58万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-30 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10298478
• 关键词: Address; Affect; Age; Alcohol consumption; Benzodiazepines; Cessation of life; Communities; Complex; Data; Diagnosis; Disadvantaged; Education; Effectiveness; Effectiveness of Interventions; Employment; Epidemic; Evaluation; Feeling suicidal; Fostering; Fright; Future; Gender; HIV; HIV Infections; HIV/HCV; Health; Health care facility; Health system; Healthcare; Healthcare Systems; Hepatitis C; Hepatitis C Prevalence; High Prevalence; Homelessness; Hospitals; Housing; Human Resources; Injury; Institution; Intervention; Intervention Studies; Interview; Knowledge; Measures; Mediating; Medical; Mental Depression; Mental Health; Military Personnel; Morbidity - disease rate; Naloxone; Needle-Exchange Programs; Opioid; Opioid Analgesics; Overdose; Pain; Participant; Patient Self-Report; Pharmaceutical Preparations; Population; Population Intervention; Population Sizes; Populations at Risk; Post-Traumatic Stress Disorders; Poverty; Prevalence; Prevention; Protocols documentation; Public Health; Randomized; Randomized Controlled Trials; Risk; Risk Behaviors; Risk Reduction; Sampling; Scientific Advances and Accomplishments; Self Efficacy; Services; Severities; Social Work; Social isolation; Social support; Societies; Specialist; Stigmatization; Structure; Substance Use Disorder; System; Testing; Time; Triad Acrylic Resin; Veterans; Work; active duty; alcohol use disorder; arm; barrier to care; base; behavior change; career; chronic pain; community setting; comorbidity; control trial; design; distrust; effectiveness evaluation; evidence base; experience; health care availability; health care service; health care service organization; health care service utilization; improved; infection rate; injection drug use; innovation; interest; intervention participants; military veteran; mortality; opioid agonist therapy; opioid epidemic; opioid overdose; opioid use; opioid use disorder; outreach; overdose prevention; peer; pragmatic trial; prescription opioid; prevent; programs; psychosocial; recruit; scale up; service providers; service utilization; social; social culture; social group; social integration; social stigma; substance use; substance use treatment; support network; theories; therapy design; trend; work-study

Abstract Military veterans in the U.S. represent one of the populations most disproportionately impacted by the current opioid crisis. With historically high rates of injury and opioid analgesic use to treat chronic pain, veterans were widely prescribed opioids (often in conjunction with benzodiazepines) during the early years of the epidemic, and have been at elevated risk of opioid-related overdose and HIV/HCV infection since. Further, current data on opioid-related harms affecting veterans are likely to understate the severity of the situation, as most studies of veterans focus on the less than 50% of veterans who use VA healthcare facilities. Veterans who use opioids and are not connected to the VA healthcare system have high rates of homelessness and experience higher prevalence of comorbid substance use disorder and mental health diagnoses than their “service-connected” counterparts. Due to these vulnerabilities and the observed barriers to testing and treatment among veterans— especially substance- and mental health-related stigma, drug naiveté, and limited support networks—veterans who use opioids represent a critical target for interventions designed to mitigate overdose and HIV/HCV risk behaviors. For socially isolated veterans and veterans with limited access to healthcare, programs that work outside of formal healthcare institutions and agencies are desperately needed. This application proposes to advance scientific understanding of the most potent and efficient way to prevent opioid-related harms among veterans by achieving the following Aims: 1) Evaluate the effectiveness of a peer-delivered, community-based education, navigation and support (CENS) intervention to reduce opioid-related risk behaviors; 2) Examine factors that mediate (e.g., knowledge, self-efficacy, self-stigma) and moderate (e.g., mental health, pain/OUD severity, age) intervention effectiveness; and 3) Explore intervention participants’ and peer outreach staff perspectives on implementation as well as barriers to and facilitators of intervention effectiveness. The proposed intervention will be delivered by three veteran peer outreach workers—one dedicated to each of the three main intervention components (Education, Navigation, and Support). The study will recruit 300 veterans with opioid use disorder to participate in a randomized controlled trial. The CENS intervention will engage 150 participants in ongoing educational sessions, healthcare and treatment navigation, and social support (involving both one-on-one and group social integration protocols) designed to improve self-efficacy, reduce self-stigma, increase service and healthcare utilization, and bolster knowledge. This study stands to contribute a timely, culturally-tailored innovation to overdose and HIV/HCV prevention-as-usual that, informed by the theory of triadic influence, directly confronts the social, intrapersonal, and structural-level barriers to opioid- related risk reduction among veterans. Study findings will be of great interest to community-based and civic healthcare organizations that provide overdose and HIV/HCV risk reduction outreach, as well as to agencies committed to improving healthcare engagement among veterans.

抽象的 美国的退伍军人是受到当前的最大影响的人口之一 阿片类药物危机。由于历史上高的损伤率和阿片类镇痛用于治疗慢性疼痛，退伍军人是 在流行病的初期 从那以后，阿片类药物过量和HIV/HCV感染的风险升高。此外，当前数据 在影响退伍军人的阿片类药物有关的危害上，可能会低估情况的严重性，因为大多数研究 退伍军人专注于使用VA医疗设施的退伍军人中不到50％。使用阿片类药物的退伍军人 并且与VA医疗系统没有连接 合并症药物使用障碍和心理健康诊断的患病率比其“服务相关” 同行。由于这些脆弱性以及在退伍军人中观察到的测试和治疗障碍 - 特别是受试者和心理健康相关的污名，毒品天真和有限的支持网络 - 退伍军人 使用阿片类药物的人是旨在减轻过量服用和艾滋病毒风险的干预措施的关键目标 行为。对于社会孤立的退伍军人和退伍军人，可以使用医疗保健的计划 迫切需要在正式的医疗机构和机构之外。此申请建议 提前科学理解对防止阿片类药物相关的危害的最有效和有效的方法 通过实现以下目的，退伍军人：1）评估基于社区的同行分配的有效性 教育，导航和支持（CEN）干预以减少与阿片类药物相关的风险行为； 2）检查 介导的因素（例如，知识，自我有效，自我污名）和中等（例如，心理健康，痛苦/OUD） 严重性，年龄）干预效率； 3）探索干预参与者和同伴外展员工 关于实施以及干预有效性的障碍和促进者的观点。这 拟议的干预将由三名资深同行外展工人进行 - 一个专门针对每个的干预措施 三个主要干预组件（教育，导航和支持）。该研究将招募300名退伍军人 使用绿化障碍参与随机对照试验。 Cens干预将与150 正在进行的教育会议，医疗保健和治疗导航以及社会支持的参与者 （涉及一对一和团体的社会融合协议）旨在提高自我效率，减少 自我污名，增加服务和医疗保健利用以及增强知识。这项研究有助于 及时的，及时的文化定制的创新过量和艾滋病毒/艾滋病毒/hcv预防，这是普遍的 三合会影响理论直接面对社会，人际关系和结构性层次的障碍。 退伍军人的相关风险降低。研究结果将引起社区和公民的极大兴趣 提供过量服用和艾滋病毒/HCV风险降低风险外展的医疗组织以及机构 致力于改善退伍军人的医疗保健参与。