Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Addiction. 2024 Jul;119(7):1276-1288. doi: 10.1111/add.16486. Epub 2024 Apr 1.
People who inject drugs (PWID) are at risk for adverse outcomes across multiple dimensions. While evidence-based interventions are available, services are often fragmented and difficult to access. We measured the effectiveness of an integrated care van (ICV) that offered services for PWID.
DESIGN, SETTING AND PARTICIPANTS: This was a cluster-randomized trial, which took place in Baltimore, MD, USA. Prior to randomization, we used a research van to recruit PWID cohorts from 12 Baltimore neighborhoods (sites), currently served by the city's mobile needle exchange program.
We randomized sites to receive weekly visits from the ICV (n = 6) or to usual services (n = 6) for 14 months. The ICV offered case management; buprenorphine/naloxone; screening for HIV, hepatitis C virus and sexually transmitted infections; HIV pre-exposure prophylaxis; and wound care.
The primary outcome was a composite harm mitigation score that captured access to evidence-based services, risk behaviors and adverse health events (range = 0-15, with higher numbers indicating worse status). We evaluated effectiveness by comparing changes in the composite score at 7 months versus baseline in the two study arms.
We enrolled 720 cohort participants across the study sites (60 per site) between June 2018 and August 2019: 38.3% women, 72.6% black and 85.1% urine drug test positive for fentanyl. Over a median of 10.4 months, the ICV provided services to 734 unique clients (who may or may not have been cohort participants) across the six intervention sites, including HIV/hepatitis C virus testing in 577 (78.6%) and buprenorphine/naloxone initiation in 540 (74%). However, only 52 (7.2%) of cohort participants received services on the ICV. The average composite score decreased at 7 months relative to baseline, with no significant difference in the change between ICV and usual services (difference in differences: -0.31; 95% confidence interval: -0.70, 0.08; P = 0.13).
This cluster-randomized trial in Baltimore, MD, USA, found no evidence that weekly neighborhood visits from a mobile health van providing injection-drug-focused services improved access to services and outcomes among people who injected drugs in the neighborhood, relative to usual services. The van successfully served large numbers of clients but unexpectedly low use of the van by cohort participants limited the ability to detect meaningful differences.
注射毒品者（PWID）在多个维度上都面临不良后果的风险。虽然有循证干预措施，但服务往往分散且难以获得。我们评估了一辆提供注射毒品者服务的综合护理车（ICV）的效果。
设计、地点和参与者：这是一项在美国马里兰州巴尔的摩市进行的集群随机试验。在随机分组之前，我们使用研究车从该市的 12 个巴尔的摩社区（站点）招募注射毒品者队列，这些社区目前由该市的流动针具交换计划提供服务。
我们将站点随机分为每周接受 ICV（n=6）或常规服务（n=6）的访问，共 14 个月。ICV 提供病例管理；丁丙诺啡/纳洛酮；艾滋病毒、丙型肝炎病毒和性传播感染的筛查；艾滋病毒暴露前预防；和伤口护理。
主要结果是综合减轻伤害评分，该评分反映了获得循证服务、风险行为和不良健康事件的情况（范围为 0-15，分数越高表示状况越差）。我们通过比较两个研究组在 7 个月和基线时的复合评分变化来评估效果。
我们在 2018 年 6 月至 2019 年 8 月期间在研究站点招募了 720 名队列参与者（每个站点 60 名）：38.3%为女性，72.6%为黑人，85.1%尿液药物测试呈芬太尼阳性。在中位数为 10.4 个月的时间里，ICV 为六个干预站点的 734 名（可能或可能不是队列参与者）独特客户提供了服务，包括 577 名（78.6%）艾滋病毒/丙型肝炎病毒检测和 540 名（74%）丁丙诺啡/纳洛酮起始。然而，只有 52 名（7.2%）队列参与者在 ICV 上接受了服务。与基线相比，7 个月时的综合评分下降，ICV 和常规服务之间的变化没有显著差异（差异差异：-0.31；95%置信区间：-0.70，0.08；P=0.13）。
在美国马里兰州巴尔的摩市进行的这项集群随机试验发现，每周由一辆提供注射毒品者服务的移动健康车对社区内注射毒品者提供注射毒品重点服务，与常规服务相比，并没有改善服务获取和结果。这辆面包车成功地为大量客户提供了服务，但令人意外的是，面包车在队列参与者中的使用率较低，限制了发现有意义差异的能力。
