Utilizing Implementation Science to Identify Barriers and Facilitators to Implementing Harm Reduction Services in the Veterans Health Administration (VHA)

Harvey, Leah; Sliwiński, S; Flike, Kimberlee; Boudreau, Jacqueline; Gifford, Allen L.; Branch‐Elliman, Westyn; Hyde, Justeen

doi:10.21203/rs.3.rs-1720487/v1

Cited by 2 publications

(1 citation statement)

References 23 publications

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“…Increasingly, implementation science (IS) is being used to aid in the planning and successful delivery of complex evidence-based interventions and their adoption among PWID in the US and abroad. Prior MOUD and harm reduction research has examined implementation facilitators and barriers within the organizational healthcare and social service systems [24][25][26][27][28][29][30][31][32], workforce capacity [33], financing, and policy contexts [34,35]. In the context of HIV and substance use, IS frameworks and methods have been leveraged in the US to articulate organization and patient perspectives of harm reduction interventions for PWID with HIV [36], improve the success of HIV prevention interventions by accounting for the unique injection contexts on HIV risk behaviors among PWID [37], and help to expand harm reduction interventions via pharmacy services directed to PWID [38].…”

Section: Introductionmentioning

confidence: 99%

A data-driven approach to implementing the HPTN 094 complex intervention INTEGRA in local communities

Smith,

Perez-Brumer,

Nicholls

et al. 2024

Implementation Sci

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Background HIV burden in the US among people who inject drugs (PWID) is driven by overlapping syndemic factors such as co-occurring health needs and environmental factors that synergize to produce worse health outcomes among PWID. This includes stigma, poverty, and limited healthcare access (e.g. medication to treat/prevent HIV and for opioid use disorder [MOUD]). Health services to address these complex needs, when they exist, are rarely located in proximity to each other or to the PWID who need them. Given the shifting drug use landscapes and geographic heterogeneity in the US, we evaluate a data-driven approach to guide the delivery of such services to PWID in local communities. Methods We used a hybrid, type I, embedded, mixed method, data-driven approach to identify and characterize viable implementation neighborhoods for the HPTN 094 complex intervention, delivering integrated MOUD and HIV treatment/prevention through a mobile unit to PWID across five US cities. Applying the PRISM framework, we triangulated geographic and observational pre-implementation phase data (epidemiological overdose and HIV surveillance data) with two years of implementation phase data (weekly ecological assessments, study protocol meetings) to characterize environmental factors that affected the viability of implementation neighborhoods over time and across diverse settings. Results Neighborhood-level drug use and geographic diversity alongside shifting socio-political factors (policing, surveillance, gentrification) differentially affected the utility of epidemiological data in identifying viable implementation neighborhoods across sites. In sites where PWID are more geographically dispersed, proximity to structural factors such as public transportation and spaces where PWID reside played a role in determining suitable implementation sites. The utility of leveraging additional data from local overdose and housing response systems to identify viable implementation neighborhoods was mixed. Conclusions Our findings suggest that data-driven approaches provide a contextually relevant pragmatic strategy to guide the real-time implementation of integrated care models to better meet the needs of PWID and help inform the scale-up of such complex interventions. This work highlights the utility of implementation science methods that attend to the impact of local community environmental factors on the implementation of complex interventions to PWID across diverse drug use, sociopolitical, and geographic landscapes in the US. Trial registration ClincalTrials.gov, Registration Number: NCT04804072. Registered 18 February 2021.

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Section: Introductionmentioning

confidence: 99%

A data-driven approach to implementing the HPTN 094 complex intervention INTEGRA in local communities

Smith,

Perez-Brumer,

Nicholls

et al. 2024

Implementation Sci

View full text Add to dashboard Cite

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“I wouldn’t need Narcan for myself, but I can have it for somebody else:” perceptions of harm reduction among hospitalized patients with OUD

French

Davis

Aronowitz

et al. 2023

Addict Sci Clin Pract

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Background Extant literature is limited on adoption of evidence-based harm reduction strategies in hospitals. We explored patient perceptions of incorporating harm reduction supplies and education in hospital care with patients with opioid use disorder (OUD). Methods Qualitative descriptive study of hospitalized patients with OUD in Philadelphia, PA using semi-structured interviews conducted between April and August of 2022. Results Three major themes emerged from 21 interviews with hospitalized patients with OUD: (1) Applicability and Acceptability of Harm Reduction Practices for Oneself; (2) Applicability and Acceptability of Harm Reduction Practices for Others; (3) Perceptions of Harm Reduction Conversations. Most participants were familiar with harm reduction but varied in their perceptions of its relevance for their lives. We noted differences in how participants viewed the applicability and acceptably of harm reduction practices that they perceived as intended to help others (e.g., naloxone) versus intended to help themselves (e.g., syringes). Most participants reported that meaningful conversations about drug use did not happen with their care team but that these conversations would have been acceptable if they were conducted in a way consistent with their individual substance use goals. Conclusions Patients' interest and perceived acceptability of harm reduction services during hospitalization varied by individual patient factors and the perceived user of specific interventions. Given their positive potential, harm reduction practices should be incorporated in hospitals, but this must be done in a way that is acceptable to patients. Our findings reveal ways to integrate concepts from a harm reduction approach within a traditional medical model. More work is needed to understand the impact of such integration.

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Utilizing Implementation Science to Identify Barriers and Facilitators to Implementing Harm Reduction Services in the Veterans Health Administration (VHA)

Cited by 2 publications

References 23 publications

A data-driven approach to implementing the HPTN 094 complex intervention INTEGRA in local communities

A data-driven approach to implementing the HPTN 094 complex intervention INTEGRA in local communities

“I wouldn’t need Narcan for myself, but I can have it for somebody else:” perceptions of harm reduction among hospitalized patients with OUD

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