Perinatal care as a venue to reduce opioid overdoses and hepatitis C virus incidence (PreVenT OD HCV)

围产期护理是减少阿片类药物过量和丙型肝炎病毒发病率 (PreVenT OD HCV) 的场所

基本信息

批准号：
10620846
负责人：
Rachel Lee Epstein
金额：
$ 17.54万
依托单位：
BOSTON MEDICAL CENTER
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：
2022-07-01 至 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10620846
关键词：
Address Adult Age Age Reporting Award Calibration Caring Child Childhood Clinic Clinical Clinical effectiveness Communicable Diseases Cost Analysis Cost effectiveness research Data Decision Modeling Diagnosis Discipline of obstetrics Epidemic Family Future Goals HIV Health Healthcare Hepatitis C Hepatitis C Incidence Hepatitis C Therapy Hepatitis C Transmission Hepatitis C virus Hospitalization Human Infant Infection Inpatients Intervention K-Series Research Career Programs Learning Link Maternal Mortality Measures Medicine Mentors Methods Modeling National Institute of Drug Abuse Opioid Outcome Overdose Overdose reduction Perinatal Perinatal Care Persons Pharmaceutical Preparations Physicians Policies Population Population Decreases Postpartum Period Predisposition Pregnancy Pregnant Women Prevalence Public Health Publishing Quality-Adjusted Life Years Recovery Research Research Personnel Resource Allocation Resources Risk Factors Role Sampling Science Seroprevalences Services Techniques Testing Time Training United States United States National Institutes of Health Visit Woman Work Youth addiction care costs care delivery care seeking career career development clinical effect comparative cost effectiveness cost cost effective cost effectiveness design disease transmission economic evaluation efficacy evaluation epidemic virus experience health care service utilization health data health economics health service use improved injection drug use innovation medication for opioid use disorder microcosting models and simulation mortality opioid epidemic opioid misuse opioid mortality opioid overdose opioid use disorder overdose death perinatal health perinatal period post pregnancy pregnancy associated death prenatal prevent programs reproductive retention rate skills substance use transmission process young woman

项目摘要

PROJECT SUMMARY/ABSTRACT Amidst the current opioid overdose crisis, 1.4 million women of reproductive age report non-medical opioid use, and opioid use disorder (OUD) prevalence among pregnant women rose five-fold from 1998-2017. Although pregnancy may be a motivating time to start medications to treat OUD, retention post-partum declines significantly and is associated with unacceptably high opioid overdose and mortality rates. Injection drug use is also the primary risk factor for hepatitis C virus (HCV) infection in the United States (U.S.). Women now comprise nearly half of new HCV infections, and HCV seroprevalence has also risen five-fold in pregnant women since 2000. Although the U.S. is committed to eliminating HCV, about 50% of people are unaware of their infection and fewer than 40% of those diagnosed have been treated. Research is needed to identify venues to increase efforts to improve OUD treatment and retention and to identify and treat current HCV infection. Perinatal care provides longitudinal access to women over a nearly one-year period, and as pregnancy may be a motivating time for women to seek care for both OUD and HCV, perinatal care may be a critical venue to reach women who inject drugs, a key population that NIDA identifies as central to the ongoing opioid crisis. Yet, little data exist to measure the role of the perinatal care venue to reach national OUD and HCV treatment goals. This study aims to create a perinatal-specific decision model and measure health service utilization and costs of a perinatal OUD and HCV intervention to identify how to leverage the perinatal care venue to decrease postpartum opioid overdoses and population-level HCV transmission. This study has two main aims: (1) to build a microsimulation model to analyze the clinical and health economic effects of leveraging the perinatal care venue to reduce opioid overdoses and population-level and infant HCV transmission; (2) to measure health services utilization and costs of incorporating MOUD and HCV treatment into perinatal care. The results of this study could help determine most efficient resource allocation to achieve national overdose and HCV elimination goals. The PI, Dr. Epstein, is an early career investigator, trained in pediatric and adult infectious diseases, with a focus on addiction medicine and HCV in pregnant women and youth. This career development award will allow her to gain expertise in 1) transmission modeling and model calibration and 2) health economic evaluation and micro-costing to be able to conduct comparative cost-effectiveness research to inform interventions for women with substance use and HCV. She has compiled an experienced team of mentors and advisors to help her achieve her training and career goals, to become an independent clinician-investigator expert in utilizing decision science to project most effective use of resources to improve care for families at the center of the opioid overdose, HCV and HIV epidemics.

项目概要/摘要在当前阿片类药物过量危机中，140 万育龄妇女报告非医用阿片类药物 1998 年至 2017 年间，孕妇中阿片类药物使用障碍 (OUD) 的流行率增加了五倍。尽管怀孕可能是开始药物治疗 OUD 的一个动机，但产后保留显着下降，并与令人无法接受的阿片类药物过量和死亡率相关。注射在美国，吸毒也是丙型肝炎病毒（HCV）感染的主要危险因素。女性现在占新发丙肝病毒感染的近一半，孕妇丙肝病毒血清流行率也上升了五倍自 2000 年以来，女性人数增加。虽然美国致力于消除 HCV，但约 50% 的人不知道他们的感染率只有不到 40% 得到了治疗。需要研究来确定场所加大力度改善 OUD 治疗和保留，并识别和治疗当前的丙肝病毒感染。围产期保健为妇女提供近一年的纵向服务，由于怀孕可能是女性寻求 OUD 和 HCV 护理的一个动机，因此围产期护理可能是接触注射吸毒妇女的关键场所，注射吸毒妇女是 NIDA 确定的关键人群持续的阿片类药物危机的核心。然而，几乎没有数据可以衡量围产期护理场所在达到国家 OUD 和 HCV 治疗目标。本研究旨在创建围产期特定决策模型衡量卫生服务利用率以及围产期 OUD 和 HCV 干预的成本，以确定如何利用围产期护理场所减少产后阿片类药物过量和人群丙型肝炎传播。本研究有两个主要目的：（1）建立微观模拟模型来分析临床和利用围产期护理场所减少阿片类药物过量和人口水平的健康经济影响和婴儿丙型肝炎病毒传播； (2) 衡量卫生服务利用率以及纳入 MOUD 和的成本 HCV 治疗纳入围产期护理。这项研究的结果可以帮助确定最有效的资源分配以实现国家用药过量和消除丙肝病毒的目标。 PI，爱泼斯坦博士，是一位早期职业人士研究员，接受过儿科和成人传染病方面的培训，重点是成瘾医学和丙型肝炎病毒孕妇和青少年。该职业发展奖将使她能够获得 1) 传输方面的专业知识建模和模型校准以及2）能够进行卫生经济评估和微观成本核算比较成本效益研究，为针对药物滥用和丙型肝炎妇女的干预措施提供信息。她组建了一支经验丰富的导师和顾问团队来帮助她实现培训和职业目标，成为利用决策科学来制定最有效方案的独立临床研究者专家利用资源改善对处于阿片类药物过量、丙型肝炎和艾滋病毒流行中心的家庭的护理。