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Systems analysis and improvement approach to improve naloxone distribution within syringe service programs: study
Christopher F Akiba1, Sheila V Patel2, Lynn D Wenger2
1RTI International, 3040 E Cornwallis Rd, Research Triangle, Research Triangle Park, NC, 27709, USA. cakiba@rti.org.
Background:
More than half a million Americans died of an opioid-related overdose between 1999 and 2020, the majority occurring between 2015 and 2020. The opioid overdose mortality epidemic disproportionately impacts Black, Indigenous, and people of color (BIPOC): since 2015, overdose mortality rates have increased substantially more among Black (114%) and Latinx (97%) populations compared with White populations (32%). This is in part due to disparities in access to naloxone, an opioid antagonist that can effectively reverse opioid overdose to prevent death. Our recent pilot work determined that many barriers to naloxone access can be identified and addressed by syringe service programs (SSPs) using the Systems Analysis and Improvement Approach to Naloxone distribution (SAIA-Naloxone). This randomized controlled trial will test SAIA-Naloxone's ability to improve naloxone distribution in general and among BIPOC specifically.
Methods:
We will conduct a trial with 32 SSPs across California, randomly assigning 16 to the SAIA-Naloxone arm and 16 to receive implementation as usual. SAIA-Naloxone is a multifaceted, multilevel implementation strategy through which trained facilitators work closely with SSPs to (1) assess organization-level barriers, (2) prioritize barriers for improvement, and (3) test solutions through iterative change cycles until achieving and sustaining improvements. SSPs receiving SAIA-Naloxone will work with a trained facilitator for a period of 12 months. We will test SAIA-Naloxone's ability to improve SSPs' naloxone distribution using an interrupted time series approach. Data collection will take place during a 3-month lead-in period, the 12-month active period, and for an additional 6 months afterward to determine whether impacts are sustained. We will use a structured approach to specify SAIA-Naloxone to ensure strategy activities are clearly defined and to assess SAIA-Naloxone fidelity to aid in interpreting study results. We will also assess the costs associated with SAIA-Naloxone and its cost-effectiveness.
Discussion:
This trial takes a novel approach to improving equitable distribution of naloxone amid the ongoing epidemic and associated racial disparities. If successful, SAIA-Naloxone represents an important organizational-level solution to the multifaceted and multilevel barriers to equitable naloxone distribution.
Insights
The Systems Analysis and Improvement Approach to Naloxone distribution (SAIA-Naloxone) aims to improve equitable access to life-saving opioid overdose reversal medication. This strategy addresses barriers within syringe service programs, particularly for disproportionately affected communities.
Area of Science:
- Public Health
- Implementation Science
- Health Equity
Background:
- The opioid overdose epidemic has caused over half a million deaths in the US since 1999, with disproportionately high mortality rates among Black, Indigenous, and people of color (BIPOC).
- Disparities in access to naloxone, an opioid overdose reversal medication, contribute to these inequities.
- Syringe service programs (SSPs) face organizational barriers to effective naloxone distribution.
Purpose of the Study:
- To evaluate the effectiveness of the Systems Analysis and Improvement Approach to Naloxone distribution (SAIA-Naloxone) strategy.
- To improve naloxone distribution rates within SSPs, with a specific focus on increasing access for BIPOC communities.
- To assess the sustainability and cost-effectiveness of the SAIA-Naloxone strategy.
Main Methods:
- A randomized controlled trial involving 32 SSPs across California, with 16 assigned to the SAIA-Naloxone arm and 16 to usual implementation.
- The SAIA-Naloxone strategy involves trained facilitators guiding SSPs through barrier assessment, prioritization, and iterative solution testing over 12 months.
- An interrupted time series approach will be used to analyze naloxone distribution data over lead-in, active, and follow-up periods.
Main Results:
- Pilot work demonstrated that SAIA-Naloxone can identify and address barriers to naloxone access.
- The trial is designed to measure improvements in naloxone distribution, both overall and for BIPOC populations.
- Fidelity and cost-effectiveness of the SAIA-Naloxone strategy will be assessed.
Conclusions:
- SAIA-Naloxone offers a novel, organizational-level solution to multifaceted barriers hindering equitable naloxone distribution.
- This strategy has the potential to significantly improve overdose prevention for vulnerable populations.
- Successful implementation could serve as a model for addressing health disparities in public health interventions.
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