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M.P.H. Candidate is Co-Author of a New Study that Shows the Success of a Clinical Team Focused on Harm Reduction for Injection Drug Use-Related Infections

Belén Hervera, M.P.H. candidate in the Department of Public Health Sciences (DPHS) at the University of Miami Miller School of Medicine, is co-author of a new study conducted by researchers from the IDEA Exchange – the first legal syringe exchange program in the state of Florida ­– where experts established a clinical team at Jackson Memorial Hospital based on harm reduction.

The study, “Integrated Infectious Disease and Substance Use Disorder Care for the Treatment of Injection Drug Use–Associated Infections: A Prospective Cohort Study With Historical Control,” was recently published in the Open Forum Infectious Diseases journal.

In the aftermath of the ongoing drug overdose crisis, hospitalizations for injection drug use (IDU)-related infectious diseases have increased. “Skin and soft tissue infections (SSTIs), endocarditis, and bloodstream infections, are examples of severe injection-related infections (SIRIs) that necessitate hospitalization,” said Hervera. Invasive bacterial and fungal infections among people who inject drugs (PWID) are both a direct cause of death and a risk factor for future harms such as overdose, HIV infection, and hepatitis C virus (HCV) infection.

Principal Investigator, David P. Serota, M.D., and Senior Author, Tyler S. Bartholomew, Ph.D., alongside other researchers at the IDEA Exchange, wanted to address the infectious disease (ID) and substance use disorder (SUD) syndemic in South Florida. To do so, they formed the Severe Injection-Related Infection (SIRI) team, an integrated ID/SUD clinical team focused on harm reduction at Jackson Memorial Hospital, a 1550-bed safety-net hospital in Miami, Florida. The SIRI team provides medical care, SUD treatment, and patient navigation during hospitalization and after release to people who inject drugs (PWID).

“People who inject drugs experience pervasive stigma and untreated withdrawal from substances when hospitalized with SIRIs, leading to high rates of patient-directed discharge and readmission. We knew there had to be a better way to serve this community within the hospital setting,” said Dr. Bartholomew, who is also a Research Associate Professor at DPHS.

In order to assess the impact of the SIRI team intervention on healthcare utilization, ID, and SUD outcomes, patients were prospectively enrolled into an observational cohort between August 2020 and May 2022. “Data were compared to a sample of patients who had previously been hospitalized at the same hospital with an IDU-associated infection in the year prior ­– 2019 –to the establishment of the SIRI team,” said Hervera.

Using a diagnostic code algorithm confirmed by chart review, researchers were able to identify a historical control group of patients.

“The primary outcome was death or readmission within 90 days of discharge from the hospital. Secondary outcomes included the start of opioid use disorder (MOUD) medications and the completion of an antibiotic course,” explained Hervera.

The study found that the use of a SIRI team intervention in 129 patients resulted in a 45% lower risk of readmission or death within 90 days when compared to pre-SIRI historical controls. Additionally, SIRI team patients were more likely to start MOUD treatment in the hospital, complete antibiotic treatment, and have a patient-directed discharge.

Other UM collaborators include:

Liza Rosenbloom, Grace Seo, Daniel J. Feaster, Ph.D., Edward Suarez, Jr., Teresa A. Chueng, Salma Hernandez, Allan E. Rodriguez, Hansel E. Tookes, Susanne Doblecki-Lewis.

Written by Deycha Torres Hernández
Published on January 23, 2023