Assessing the Reach, Effectiveness, and Implementation of Multiple Interventions

Research Triangle Institute, Durham NC

Investigators

Abstract

We propose to assess the reach, effectiveness, adoption, implementation, and maintenance of existing and emerging interventions designed to improve the health of drug users who inject or smoke illicit drugs. The major health complications associated with injecting or smoking heroin, fentanyl analogs, methamphetamine, and cocaine include addiction, overdoses, viruses and bacterial infections (e.g., skin and soft tissue infection and endocarditis). Steep increases in morbidity and mortality associated with drug use have motivated people to conceptualize and implement innovative interventions to thwart these health emergencies. We do not know how well these interventions work in tandem with each other. As such, we need scientifically rigorous evaluations to determine how effective they are and whether their implementation is conducted optimally. Scientific evaluations play a critical role in assessing whether emerging and existing interventions are not only effective within real world delivery contexts but also how implementation can be improved. The RE-AIM implementation science framework helps guide evaluations by considering their Reach, Effectiveness, Adoption, Implementation, and Maintenance. Our aims are as follows: Aim 1: Assess changes in and factors associated with access to an array of services for drug users who inject or smoke illicit drugs over time (Reach). Aim 2: Determine the effectiveness of existing and emerging services in reducing drug use, addiction, and overdose risk among drug users who inject or smoke illicit drugs (Effectiveness). Aim 3: Explore adoption, implementation, and maintenance of services for drug users within organizations that serve them over time (Adoption, Implementation, and Maintenance). To achieve Aims 1 and 2, we will conduct a serial cross-sectional study of drug users who inject or smoke heroin, fentanyl analogs, methamphetamine, or cocaine. In each of 4 years, a new sample (n=800) of drug users who inject or smoke illicit drugs will be recruited using targeted sampling methods. Surveys will ascertain access to and use of various interventions and the medical consequences of using drugs. Part of the analyses will be to assess the effectiveness of overlapping interventions and services. To achieve Aim 3, we will conduct a serial cross-sectional qualitative study consisting of qualitative interviews with staff (n=30 annually) at organizations that provide services to drug users (n=10) to assess adoption, implementation, and maintenance of these services. Our investigative team includes an epidemiologist (Alex Kral), an implementation scientist (Barrot Lambdin), a general internal medicine physician (Leslie Suen), and a statistician (Jason Williams) and has 3 decades of experience conducting evaluation research with drug users. Our proposed study will provide data on access to, implementation of, and impact of emerging and evolving interventions designed to help drug users, thereby helping US policymakers and service providers move effective services along the continuum towards scaled implementation and maintenance.