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A Study Protocol to Increase Engagement in Evidence-Based Hospital and Community-Based Care Using a Serious

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A new checklist and peer support intervention can improve healthcare engagement for hospitalized individuals with serious injection-related infections (SIRIs). This approach aims to increase screenings for HIV, HCV, and medication for opioid use disorder (MOUD).

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Area of Science:

  • Public Health
  • Infectious Diseases
  • Addiction Medicine

Background:

  • Serious injection-related infections (SIRIs), including endocarditis, are rising due to the ongoing drug crisis.
  • Hospitalizations present a critical but often missed opportunity to connect persons who inject drugs (PWID) with essential healthcare services.
  • Current care models often fail to adequately address the complex needs of PWID, leading to poor engagement in treatment and prevention.

Purpose of the Study:

  • To evaluate the feasibility and effectiveness of a standardized "SIRI Checklist" and an "Intensive Peer Recovery Coach" intervention for hospitalized PWID with SIRIs.
  • To determine if these interventions increase screening rates for Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV), and the uptake of medication for opioid use disorder (MOUD).
  • To assess the impact on linkage to care, including pre-exposure prophylaxis (PrEP) prescriptions, MOUD prescriptions, and subsequent outpatient visits.

Main Methods:

  • A feasibility study and randomized controlled trial (RCT) involving 60 hospitalized PWID diagnosed with SIRIs.
  • Participants will be randomized into four groups: SIRI Checklist only, SIRI Checklist + Intensive Peer Intervention, Intensive Peer Intervention only, and Standard of Care.
  • A 2x2 factorial design will be used for analysis, focusing on recruitment, retention, and clinical outcomes such as HIV/HCV testing, MOUD, and PrEP prescriptions.

Main Results:

  • The study aims to assess the ability to recruit and retain hospitalized PWID in the intervention arms.
  • Key clinical outcomes to be measured include rates of HIV and HCV testing, initiation of MOUD, and prescription of PrEP.
  • The study will analyze the effectiveness of the SIRI Checklist and Intensive Peer Intervention in promoting engagement with community-based care.

Conclusions:

  • The SIRI Checklist and Intensive Peer Intervention show promise as low-barrier, reproducible models for improving healthcare access for hospitalized PWID.
  • These interventions are designed to facilitate linkage and sustained engagement in community-based care, addressing critical public health challenges.
  • Successful implementation could lead to improved health outcomes for PWID, reducing the burden of infectious diseases and substance use disorders.