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 美国退伍军人是受当前疫情影响最严重的人群之一 阿片类药物危机。由于历史上的高受伤率和使用阿片类药物镇痛来治疗慢性疼痛，退伍军人 在流行病的早期，广泛使用阿片类药物（通常与苯二氮卓类药物结合使用）， 此后，阿片类药物相关过量服用和 HIV/HCV 感染的风险升高。 关于影响退伍军人的阿片类药物相关危害可能低估了情况的严重性，因为大多数研究 的退伍军人关注使用 VA 医疗机构的不到 50% 的退伍军人 使用阿片类药物的退伍军人。 且未连接至 VA 医疗保健系统 无家可归率较高且经历较高 共病物质使用障碍和心理健康诊断的患病率高于其“服务相关” 由于这些脆弱性以及退伍军人在检测和治疗方面观察到的障碍—— 尤其是与物质和心理健康相关的耻辱、吸毒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用药过量和艾滋病毒/丙型肝炎风险的干预措施的关键目标 对于社会孤立的退伍军人和获得医疗保健机会有限的退伍军人，有效的计划。 正规医疗机构和机构之外迫切需要此应用程序。 对预防阿片类药物相关危害的最有效的先进方法的科学认识 通过实现以下目标来帮助退伍军人： 1) 评估同行交付的、基于社区的项目的有效性 教育、导航和支持 (CENS) 干预，以减少阿片类药物相关的危险行为；2) 检查 中介因素（例如知识、自我效能、自我耻辱）和调节因素（例如心理健康、疼痛/OUD） 严重程度、年龄）干预效果；以及 3）探索干预参与者和同伴外展人员 对实施的看法以及干预效果的障碍和促进因素。 拟议的干预措施将由三名经验丰富的同伴外展工作人员进行——一名专门负责每个 该研究将招募 300 名退伍军人，包括三个主要干预部分（教育、引导和支持）。 患有阿片类药物使用障碍的人参加一项随机对照试验，CENS 干预措施将吸引 150 名患者参与。 持续教育课程、医疗保健和治疗导航以及社会支持的参与者 （涉及一对一和团体社会融入协议）旨在提高自我效能，减少 自我耻辱，增加服务和医疗保健利用率，并增强知识。这项研究将做出贡献。 及时、根据文化定制的创新，以防止过量用药和艾滋病毒/丙型肝炎病毒/丙肝病毒的预防， 三元影响理论，直接面对阿片类药物的社会、个人内部和结构层面的障碍 研究结果将引起社区和公民的极大兴趣。 提供药物过量和 HIV/HCV 风险降低外展服务的医疗保健组织以及机构 致力于提高退伍军人的医疗保健参与度。