Systems analysis and improvement approach to improve naloxone distribution within syringe service programs: study protocol of a randomized controlled trial

Implementation Science

Study Protocol

Peter J. Davidson¹  Stephen Orme²  Gary A. Zarkin²  Antonio Morgan-Lopez²  Christopher F. Akiba²  Alex H. Kral²  Sheila V. Patel²  Barrot H. Lambdin²  Lynn D. Wenger² 

[1] Department of Medicine, Division Global Public Health, UCSD, 9500 Gilman Dr, 92093, La Jolla, CA, USA;RTI International, 3040 E Cornwallis Rd, Research Triangle, 27709, Research Triangle Park, NC, USA;

关键词: Systems Analysis and Improvement Approach;    Opioid overdose deaths;    Equitable naloxone distribution;    Randomized controlled trial;    Syringe service programs;   

DOI  :  10.1186/s13012-023-01288-x

 received in 2023-06-05, accepted in 2023-07-24,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundMore 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.MethodsWe 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.DiscussionThis 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.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

13570_2023_282_Article_IEq8.gif

13570_2023_282_Article_IEq4.gif