Strategies to reduce serious bacterial infections and overdose among people who inject drugs

PROJECT SUMMARY
Serious bacterial infections including infective endocarditis and skin and soft tissue infections are
among the most common medical complications in persons who inject drugs (PWID). Hospitalizations for
injection-related infective endocarditis increased twelve-fold between 2010 and 2015 and for heroin-related
skin and soft tissue infections doubled over the last two decades. Costs of these diseases have also increased
dramatically.
While there are ongoing hospital-based programs to reduce injection-related bacterial infections, their
long-term effectiveness, costs, and cost-effectiveness are unknown. Longitudinal investigation of these
interventions is urgently needed to improve outcomes given the rapid expansion of the US opioid epidemic, but
is challenging due to the relapsing nature of OUD, the heterogeneous nature of persons who inject opioids,
and the shifting nature of the drug supply. Simulation modeling can augment evidence from trials by projecting
the clinical and economic outcomes over longer time horizons for different populations. This proposed research
will use simulation modeling to examine the impact of changes in injection opioid use practices as well as
hospital-based interventions aimed at addressing the underlying OUD on the incidence of injection-related
bacterial infections with the following scientific aims:
Aim 1: To develop a simulation model of injection opioid use to project long-term incidence, outcomes, and
costs of injection-related infective endocarditis, skin and soft tissue infections, and overdose. Aim 2: To
estimate the clinical impact, costs, and cost-effectiveness of hospital-initiated addiction care and rapid-access
linkage to post-hospital medication treatment for persons who inject opioids. Aim 3: To perform a
comprehensive economic evaluation alongside an ongoing clinical trial and to use the simulation model to
estimate the long-term clinical effectiveness of a hospital-based skin and needle hygiene program aimed to
prevent bacterial infections among persons who inject opioids.
During the K01 project period, the candidate will develop a specific skill set in three primary domains:
(1) advanced quantitative methods for simulation modeling; (2) understanding the design, operationalization,
and evaluation of hospital-based interventions for PWID; and (3) measuring healthcare utilization and cost-
effectiveness analyses alongside clinical trials. Training will be accomplished through an intensive combination
of formal structured courses, training workshops and field experiences, applied research experience, and
focused mentorship in mathematical modeling, biostatistics, addiction, hospital-based interventions, and health
economics. Acquisition of these skills will allow the candidate to accomplish his long-term goal, which is to
become an independently-funded investigator and global expert on clinical decision making and health policy
at the intersection of substance use and infectious diseases.

Grant Number: 5K01DA051684-06
NIH Institute/Center: NIH
Principal Investigator: Joshua Barocas