Assessing the Reach, Effectiveness, and Implementation of Multiple Harm Reduction Interventions.

评估多种减少危害干预措施的范围、有效性和实施情况。

基本信息

批准号：
10587283
负责人：
ALEXANDER H KRAL
金额：
$ 207.08万
依托单位：
RESEARCH TRIANGLE INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-30 至 2025-09-29
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10587283
关键词：
Adoption Bacterial Infections California Cities Cocaine Communities Consumption Cross-Sectional Studies Data Drug Legislation Drug usage Drug user Effectiveness Effectiveness of Interventions Emergency Situation Endocarditis Environment Epidemic Epidemiologist Epidemiology Evaluation Evaluation Research Fentanyl Funding HIV Harm Reduction Health Hepatitis Heroin Illicit Drugs Internal Medicine Intervention Maintenance Methamphetamine Methods Morbidity - disease rate Movement Naloxone Needle-Exchange Programs Organizational Policy Overdose Persons Pharmaceutical Preparations Physicians Play Policy Maker Public Health Reach Effectiveness Adoption Implementation and Maintenance Recording of previous events Role Sampling San Francisco Scientific Evaluation Scientist Services Site Skin Tissue Smoke Smoking Soft Tissue Infections Spectroscopy, Fourier Transform Infrared Statutes and Laws Surveys Time United States Viral analog base design drug market effectiveness evaluation evidence base experience implementation framework improved innovation mortality novel opioid overdose overdose education recruit service providers social stigma test strip therapy design trend

项目摘要

PROJECT SUMMARY/ABSTRACT We propose to assess the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) of existing and emerging harm reduction services designed to improve the health of people who inject or smoke illicit drugs in San Francisco, California. The major health complications associated with injecting or smoking heroin, fentanyl analogs, methamphetamine, and cocaine include overdoses and viral (e.g., HIV, hepatitis) and bacterial infections (e.g., skin and soft tissue infection and endocarditis). Steep increases in morbidity and mortality associated with drug use have motivated people in community-based organizations to conceptualize and implement innovative harm reduction interventions to thwart these health emergencies. The burgeoning HIV epidemic spawned syringe service programs (SSPs) in the late 1980s. Rising opioid overdose mortality spawned overdose education and naloxone distribution (OEND) in the late 1990s. The recent emergence of fentanyl analogs in the illicit drug market spawned fentanyl test strips (FTS), community-based Fourier-transform infrared spectroscopy drug checking (FTIR), and safe consumption sites (SCS). Now, the re-emergence of methamphetamine has spawned a methamphetamine sobering center opening in San Francisco in 2022. Given the staggered implementation of harm reduction services over the past 35 years, the state of the evidence base varies for each. The RE-AIM implementation science framework helps guide evaluations by considering their Reach, Effectiveness, Adoption, Implementation, and Maintenance. Our aims are as follows: Aim 1: Assess changes in and factors associated with equitable access to an array of harm reduction services for people who inject or smoke illicit drugs in San Francisco over time (Reach). Aim 2: Determine the effectiveness of existing and emerging harm reduction services in reducing drug-related harm among people who inject or smoke illicit drugs in San Francisco (Effectiveness). Aim 3: Explore Adoption, Implementation, and Maintenance of harm reduction services within community- based organizations over time (Adoption, Implementation, and Maintenance). To achieve Aims 1 and 2, we will recruit people who use drugs (PWUD) using targeted sampling into a serial cross-sectional study. In each of 4 years, a new sample (n=800) of PWUD will be recruited and surveys will ascertain access to and use of various existing and emerging harm reduction interventions and drug-related harm. To achieve Aim 3, we will conduct a serial cross-sectional qualitative study of staff (n=30 annually) at all community-based organizations that provide harm reduction services in San Francisco (currently n=10) to assess Adoption, Implementation, and Maintenance. Our proposed study will provide data on access to, implementation of, and impact of emerging and evolving harm reduction interventions designed to reduce drug-related harm, thereby helping US policymakers and service providers move effective services along the continuum toward scaled implementation and maintenance.

项目概要/摘要我们建议评估其范围、有效性、采用、实施和维护（RE-AIM）旨在改善注射或吸烟者健康的现有和新兴减害服务加利福尼亚州旧金山的非法药物。与注射或吸烟相关的主要健康并发症海洛因、芬太尼类似物、甲基苯丙胺和可卡因包括过量和病毒（例如艾滋病毒、肝炎）和细菌感染（例如皮肤和软组织感染和心内膜炎）。发病率急剧上升与吸毒相关的死亡率促使社区组织的人们构思并实施创新的减少危害干预措施，以阻止这些突发卫生事件。 20 世纪 80 年代末，艾滋病毒流行迅速蔓延，催生了注射器服务计划 (SSP)。阿片类药物崛起 20 世纪 90 年代末，药物过量死亡率引发了药物过量教育和纳洛酮分发 (OEND)。这最近非法药物市场上出现的芬太尼类似物催生了芬太尼试纸（FTS），基于社区的傅立叶变换红外光谱药物检查 (FTIR) 和安全消费场所（南海）。现在，甲基苯丙胺的重新出现催生了甲基苯丙胺清醒中心将于 2022 年在旧金山开业。鉴于减少危害服务在过去 35 年，证据基础的状况各不相同。 RE-AIM 实施科学框架通过考虑其范围、有效性、采用、实施和维护。我们的目标如下：目标 1：评估公平的变化和相关因素为旧金山注射或吸食非法药物的人提供一系列减少伤害服务随着时间的推移（达到）。目标 2：确定现有和新兴减害服务的有效性减少旧金山注射或吸食非法药物者与毒品相关的伤害（效果）。目标 3：探索社区内减少伤害服务的采用、实施和维护 - 随着时间的推移，基于组织（采用、实施和维护）。为了实现目标 1 和 2，我们将通过有针对性的抽样招募吸毒者（PWUD）进行系列横断面研究。在每隔 4 年，将招募一个新的 PWUD 样本（n=800），并进行调查以确定其获得和利用各种现有和新兴的减少危害干预措施和与毒品相关的危害。为了实现目标 3，我们将对所有社区的工作人员（每年 30 名）进行一系列横断面定性研究在旧金山提供减少伤害服务的组织（目前 n=10）来评估收养情况，实施和维护。我们提出的研究将提供有关访问、实施的数据，以及旨在减少毒品相关危害的新兴和不断发展的减少危害干预措施的影响，从而帮助美国政策制定者和服务提供商沿着连续统一体推动有效服务规模化实施和维护。