Implementing and evaluating the impact of novel mobile harm reduction services on overdose among women who use drugs: The SHOUT study.

实施和评估新型移动减害服务对吸毒女性过量用药的影响：SHOUT 研究。

• 批准号: 10590364
• 负责人: Susan G. Sherman
• 金额: $ 228.96万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 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/10590364
• 关键词: AIDS prevention; Abate; Acute; Address; Adoption; American; Area; Back; Baltimore; Behavioral; Behavioral Model; Buprenorphine; COVID-19; COVID-19 pandemic; Case Management; Cessation of life; Cities; Client; Clinical Services; Clothing; Communities; Cost Effectiveness Analysis; Counseling; County; Drops; Drug usage; Drug user; Educational workshop; Effectiveness; Emergency Situation; Environment; Epidemic; Fentanyl; Food; Future; Grant; HIV; HIV/STD; Hand; Harm Reduction; Health; Health Priorities; Health Services; Health Services Accessibility; Hepatitis C virus; High Risk Woman; Homelessness; Hunger; Impact evaluation; Individual; Interpersonal Violence; Intervention; Interview; Legal; Letters; Literature; Maintenance; Maryland; Measures; Medical; Mental Depression; Mental Health; Modeling; Morbidity - disease rate; Naloxone; Neighborhoods; Outcome Study; Overdose; Pattern; Pharmaceutical Preparations; Pharmacotherapy; Phase; Population; Post-Traumatic Stress Disorders; Primary Health Care; Process; Reach Effectiveness Adoption Implementation and Maintenance; Reporting; Research; Research Personnel; Respondent; Risk; Sampling; Service delivery model; Services; Shelter facility; Site; Social Work; Sterility; Stimulant; Syringes; Testing; Trauma; Trust; Underserved Population; Visit; Vulnerable Populations; Woman; Work; analog; arm; barrier to care; base; clinical care; clinically relevant; condoms; cost effectiveness; drug market; effectiveness implementation design; effectiveness implementation study; experience; future implementation; gender-based violence; health care availability; high risk; implementation determinants; implementation outcomes; improved; informant; innovation; mHealth; medically necessary care; meetings; multidisciplinary; novel; outreach; outreach program; overdose death; overdose risk; pandemic disease; polysubstance use; prevention service; primary outcome; recruit; scaffold; scale up; service delivery; service engagement; service providers; sex; social; success; synthetic opioid

Project Summary Nearly 92,000 Americans died of drug overdoses in 2020, primarily driven by a lethal drug supply dominated by synthetic opioids (i.e., fentanyl and fentanyl analogs) and increased stimulant-related deaths. We have documented the magnitude of this epidemic experienced by women who use drugs (WWUD) (N=385) in Baltimore City, who reported high rates of experiencing an overdose (28%), witnessing a fatal overdose (35%), and witnessing a non-fatal overdose (52%) in the past 6 months. We have also documented a number of structural vulnerabilities (i.e., homelessness, hunger), mental health morbidities (i.e., PTSD, depression), interpersonal violence, and chaotic drug use patterns (i.e., polysubstance use,) that indirectly and directly drive women’s distinct risk of overdose and other morbidities (i.e., HIV, HCV). Yet WWUD experience numerous barriers to receiving necessary medical and behavioral services that can reduce their risk of overdose and other harms, with barriers amplified by the COVID-19 pandemic. We propose conducting the SHOUT (Sustained Harm reduction OUTreach) study, a type 1 hybrid effectiveness-implementation design to evaluate the impact and implementation of WWUD-centered, mobile harm reduction services on nonfatal overdose and clinical care engagement among WWUD (N=400) recruited from Baltimore City and County neighborhoods new to Mobile SPARC services. Mobile SPARC is an existing low-barrier, outreach program serving other neighborhood and offers harm reduction supplies (i.e., sterile syringes, naloxone, condoms), necessities (i.e., food, clothing), trauma informed micro-counseling, and necessary referrals The study aims to: 1) adapt and expand Mobile SPARC’s services to identify predisposing (i.e., drug use patterns) and enabling (i.e., access to trusted health services) factors that facilitate or hinder utilization of harm reduction services, employing in- depth interviews with WWUD (N=40) and key informant interviews with Mobile SPARC staff (N=5); 2) evaluate the impact of expanding Mobile SPARC on nonfatal overdose and clinical service engagement (including drug treatment) over 18 months among WWUD (N=400) recruited from neighborhoods in which Mobile SPARC will be newly implemented; and 3) to characterize the implementation of Mobile SPARC using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to inform future implementation and scale up. The SHOUT study will make a significant contribution to the literature in evaluating the impact of tailored, low-barrier mobile outreach on overdose among WWUD. The study’s relevance and sustainability will be enhanced through its partnership with SPARC, input from a community advisory board, and support of long- term collaborating organizations and health department stakeholders as well as the cost effectiveness analysis. This proposal is highly responsive to the RFA DA-22-046’s emphasis on replicable harm reduction service delivery model targeting underserved populations at high risk of overdose.

项目概要 2020 年，近 92,000 名美国人死于药物过量，主要原因是致命药物供应 以合成阿片类药物（即芬太尼和芬太尼类似物）为主，与兴奋剂相关的死亡人数增加。 记录了吸毒妇女 (WWUD) (N=385) 所经历的这种流行病的严重程度 巴尔的摩市报告吸毒过量的比率很高（28%），目睹了一次致命的吸毒过量（35%）， 在过去 6 个月内，我们还目睹了一些非致命的服药过量事件（52%）。 结构性脆弱性（即无家可归、饥饿）、心理健康疾病（即创伤后应激障碍（PTSD）、抑郁症）、 人际暴力和混乱的吸毒模式（即多物质使用）间接和直接驱动 女性服用药物过量和其他疾病（即艾滋病毒、丙型肝炎病毒）的风险明显增加，但 WWUD 却经历了许多此类事件。 接受必要的医疗和行为服务的障碍，这些服务可以降低他们服药过量的风险， 我们建议开展“SHOUT”活动，以应对其他危害。 （持续减害 OUTreach）研究，一种用于评估的 1 类混合有效性实施设计 以 WWUD 为中心的移动减害服务对非致命性用药过量的影响和实施 从巴尔的摩市和县社区招募的 WWUD (N=400) 的临床护理参与度 Mobile SPARC 服务的新功能 Mobile SPARC 是一项现有的低门槛外展计划，服务于其他领域。 邻里并提供减少危害的用品（即无菌注射器、纳洛酮、避孕套）、必需品（即 食物、衣服）、创伤知情微咨询和必要的转介 该研究的目的是：1）适应和 扩展 Mobile SPARC 的服务，以识别诱发因素（即药物使用模式）和促成因素（即获得 值得信赖的卫生服务）促进或阻碍利用减少伤害服务的因素，采用in- 与 WWUD (N=40) 的深度访谈以及与 Mobile SPARC 工作人员 (N=5) 的关键知情人访谈 2) 评估 扩大 Mobile SPARC 对非致命性用药过量和临床服务参与（包括药物 从 Mobile SPARC 所在社区招募的 WWUD (N=400) 中接受治疗）超过 18 个月 新实施；以及 3) 描述使用 Reach 的 Mobile SPARC 实施， 有效性、采用、实施、维护 (RE-AIM) 框架为未来的实施提供信息 并扩大规模 SHOUT 研究将为评估影响的文献做出重大贡献。 WWUD 中针对用药过量问题的定制、低门槛移动宣传活动将具有相关性和可持续性。 通过与 SPARC 的合作、社区咨询委员会的投入以及长期的支持来增强 术语合作组织和卫生部门利益相关者以及成本效益 该提案高度响应 RFA DA-22-046 对可复制危害减少的强调。 针对服药过量风险高、服务不足的人群的服务提供模式。