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

基本信息

批准号：
10625422
负责人：
Joshua Adam Barocas
金额：
$ 15.81万
依托单位：
UNIVERSITY OF COLORADO DENVER
依托单位国家：
美国
项目类别：
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/10625422
关键词：
Address Affect 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 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 Public Health Quality of life Relapse Research Research Personnel Resources Risk Risk Factors Risk Reduction Sepsis Skin Skin Tissue Soft Tissue Infections Sterility Stimulant Structure Time Training addiction 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 medication for opioid use disorder models and simulation mortality multidisciplinary non-opioid analgesic novel opioid epidemic opioid injection opioid use opioid use disorder prescription opioid prevent preventive intervention programs skill acquisition skills substance use tool

项目摘要

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。

项目成果

期刊论文数量（17）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Using Evidence to Inform Legislation Aimed at Curbing Fentanyl Deaths.

利用证据为旨在遏制芬太尼死亡的立法提供信息。

DOI：
10.1001/jamahealthforum.2022.5202
发表时间：
2023
期刊：
JAMA health forum
影响因子：
0
作者：
Jurecka,ColeA;Barocas,JoshuaA
通讯作者：
Barocas,JoshuaA

Crisis stabilization units for jail diversion: A preliminary assessment of patient characteristics and outcomes.

DOI：
10.1037/ser0000616
发表时间：
2022-11
期刊：
PSYCHOLOGICAL SERVICES
影响因子：
2.3
作者：
Zielinski, Melissa J.;Praseuth, Amanda;Gai, Mam Jarra;Evans, Lisa J.;Zaller, Nickolas D.;Umar, Imaan;Barocas, Joshua A.
通讯作者：
Barocas, Joshua A.

Long-term Infective Endocarditis Mortality Associated With Injection Opioid Use in the United States: A Modeling Study.

DOI：
10.1093/cid/ciaa1346
发表时间：
2021-12-06
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
0
作者：
Barocas, Joshua A;Eftekhari Yazdi, Golnaz;Linas, Benjamin P
通讯作者：
Linas, Benjamin P

Simulated Cost-effectiveness and Long-term Clinical Outcomes of Addiction Care and Antibiotic Therapy Strategies for Patients With Injection Drug Use-Associated Infective Endocarditis.

DOI：
10.1001/jamanetworkopen.2022.0541
发表时间：
2022-02-01
期刊：
JAMA network open
影响因子：
13.8
作者：
Adams JW;Savinkina A;Hudspeth JC;Gai MJ;Jawa R;Marks LR;Linas BP;Hill A;Flood J;Kimmel S;Barocas JA
通讯作者：
Barocas JA

Caring for COVID's most vulnerable victims: a safety-net hospital responds.