Strategies to reduce serious bacterial infections and overdose among people who inject drugs

减少注射吸毒者严重细菌感染和过量用药的策略

• 批准号: 10038052
• 负责人: Joshua Adam Barocas
• 金额: $ 17.26万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10038052
• 关键词: Address; Affect; Alcohol or Other Drugs use; Amputation; Applied Research; Attention; Bacterial Infections; Biometry; Cardiac Surgery procedures; Caring; Cessation of life; Chronic; Clinical; Clinical Research; Clinical Trials; Clinical effectiveness; Communicable Diseases; Communities; Cost Effectiveness Analysis; Cost of Illness; Data; Disease; Drug usage; Education; Educational workshop; Effectiveness; Endocarditis; Ensure; Epidemic; Epidemiology; Evaluation; Evolution; Fentanyl; Funding; Future; Goals; HIV; HIV/HCV; Health Care Costs; Health Policy; Healthcare Systems; Hepatitis C virus; Heroin; Hospitalization; Hospitals; Hygiene; Incidence; Infection; Infection prevention; Infective endocarditis; Injecting drug user; Injections; Intervention; Investigation; Mathematical Model Simulation; Measures; Medicine; Mentorship; Methodology; Methods; Modeling; Nature; Needles; Opioid; Oral Ingestion; Outcome; Overdose; Patients; Persons; Pharmaceutical Preparations; Population; Positioning Attribute; Preventive Intervention; Public Health; Quality of life; Relapse; Research; Research Personnel; Resources; Risk; Risk Factors; Sepsis; Skin; Skin Tissue; Soft Tissue Infections; Sterility; Structure; Time; Touch sensation; Training; addiction; base; clinical decision-making; combat; cost; cost effectiveness; cost outcomes; design; economic evaluation; economic outcome; experience; health care service utilization; health economics; high risk population; improved outcome; injection drug use; innovation; mathematical model; medical complication; models and simulation; multidisciplinary; non-opioid analgesic; novel; opioid epidemic; opioid injection; opioid use; opioid use disorder; prescription opioid; prevent; programs; skill acquisition; skills; tool

PROJECT SUMMARY Serious bacterial infections including infective endocarditis and skin and soft tissue infections are among the most common medical complications in persons who inject drugs (PWID). Hospitalizations for injection-related infective endocarditis increased twelve-fold between 2010 and 2015 and for heroin-related skin and soft tissue infections doubled over the last two decades. Costs of these diseases have also increased dramatically. While there are ongoing hospital-based programs to reduce injection-related bacterial infections, their long-term effectiveness, costs, and cost-effectiveness are unknown. Longitudinal investigation of these interventions is urgently needed to improve outcomes given the rapid expansion of the US opioid epidemic, but is challenging due to the relapsing nature of OUD, the heterogeneous nature of persons who inject opioids, and the shifting nature of the drug supply. Simulation modeling can augment evidence from trials by projecting the clinical and economic outcomes over longer time horizons for different populations. This proposed research will use simulation modeling to examine the impact of changes in injection opioid use practices as well as hospital-based interventions aimed at addressing the underlying OUD on the incidence of injection-related bacterial infections with the following scientific aims: Aim 1: To develop a simulation model of injection opioid use to project long-term incidence, outcomes, and costs of injection-related infective endocarditis, skin and soft tissue infections, and overdose. Aim 2: To estimate the clinical impact, costs, and cost-effectiveness of hospital-initiated addiction care and rapid-access linkage to post-hospital medication treatment for persons who inject opioids. Aim 3: To perform a comprehensive economic evaluation alongside an ongoing clinical trial and to use the simulation model to estimate the long-term clinical effectiveness of a hospital-based skin and needle hygiene program aimed to prevent bacterial infections among persons who inject opioids. During the K01 project period, the candidate will develop a specific skill set in three primary domains: (1) advanced quantitative methods for simulation modeling; (2) understanding the design, operationalization, and evaluation of hospital-based interventions for PWID; and (3) measuring healthcare utilization and cost- effectiveness analyses alongside clinical trials. Training will be accomplished through an intensive combination of formal structured courses, training workshops and field experiences, applied research experience, and focused mentorship in mathematical modeling, biostatistics, addiction, hospital-based interventions, and health economics. Acquisition of these skills will allow the candidate to accomplish his long-term goal, which is to become an independently-funded investigator and global expert on clinical decision making and health policy at the intersection of substance use and infectious diseases.

项目概要 严重的细菌感染，包括感染性心内膜炎以及皮肤和软组织感染 是注射吸毒者 (PWID) 最常见的医疗并发症之一。住院治疗 2010 年至 2015 年间，注射相关感染性心内膜炎和海洛因相关感染性心内膜炎增加了 12 倍 皮肤和软组织感染在过去二十年中翻了一番。这些疾病的费用也增加了 戏剧性地。 虽然正在进行以医院为基础的项目来减少注射相关的细菌感染，但它们 长期效果、成本和成本效益未知。对这些的纵向调查 鉴于美国阿片类药物流行病的迅速蔓延，迫切需要采取干预措施来改善结果，但是 由于 OUD 的复发性、注射阿片类药物的人的异质性、 以及毒品供应性质的变化。仿真建模可以通过预测来增强试验证据 不同人群在较长时间内的临床和经济结果。这项拟议的研究 将使用模拟模型来检查注射阿片类药物使用实践变化的影响以及 以医院为基础的干预措施，旨在解决注射相关事件发生率的潜在 OUD 细菌感染具有以下科学目的： 目标 1：开发注射阿片类药物使用的模拟模型，以预测长期发病率、结果和 注射相关感染性心内膜炎、皮肤和软组织感染以及用药过量的费用。目标 2： 评估医院发起的成瘾护理和快速获取的临床影响、成本和成本效益 与注射阿片类药物的人的出院后药物治疗的联系。目标 3：执行 综合经济评估以及正在进行的临床试验，并使用模拟模型 评估以医院为基础的皮肤和针头卫生计划的长期临床效果，旨在 预防注射阿片类药物的人发生细菌感染。 在 K01 项目期间，候选人将在三个主要领域培养特定技能： (1)先进的仿真建模定量方法； (2)了解设计、可操作性， 以及对注射吸毒者医院干预措施的评估； (3) 衡量医疗保健利用率和成本- 有效性分析与临床试验一起进行。培训将通过强化组合来完成 正式的结构化课程、培训研讨会和现场经验、应用研究经验，以及 数学建模、生物统计学、成瘾、医院干预和健康方面的重点指导 经济学。获得这些技能将使候选人能够实现他的长期目标，即 成为临床决策和卫生政策方面独立资助的研究者和全球专家 在物质使用和传染病的交叉点。