Abstract
BackgroundSkin and soft tissue infections (SSTIs) are a leading cause of morbidity and mortality among people who inject drugs (PWID). International data indicate up to one third of PWID have experienced an SSTI within the past month. Complications include sepsis, endocarditis and amyloid A (AA) amyloidosis. AA amyloidosis is a serious sequela of chronic SSTI among PWID. Though there is a paucity of literature reporting on AA amyloidosis among PWID, what has been published suggests there is likely a causal relationship between AA amyloidosis and injecting-related SSTI. If left untreated, AA amyloidosis can lead to renal failure; premature mortality among diagnosed PWID is high. Early intervention may reverse disease. Despite the high societal and individual burden of SSTI among PWID, empirical evidence on the barriers and facilitators to injecting-related SSTI prevention and care or the feasibility and acceptability of AA amyloidosis screening and treatment referral are limited. This study aims to fill these gaps and assess the prevalence of AA amyloidosis among PWID.MethodsCare and Prevent is a UK National Institute for Health Research-funded mixed-methods study. In five phases (P1–P5), we aim to assess the evidence for AA amyloidosis among PWID (P1); assess the feasibility of AA amyloidosis screening, diagnostic and treatment referral among PWID in London (P2); investigate the barriers and facilitators to AA amyloidosis care (P3); explore SSTI protection and risk (P4); and co-create harm reduction resources with the affected community (P5). This paper describes the conceptual framework, methodological design and proposed analysis for the mixed-methods multi-phase study.ResultsWe are implementing the Care and Prevent protocol in London. The systematic review component of the study has been completed and published. Care and Prevent will generate an estimate of AA amyloidosis prevalence among community recruited PWID in London, with implications for the development of screening recommendations and intervention implementation. We aim to recruit 400 PWID from drug treatment services in London, UK.ConclusionsCare and Prevent is the first study to assess screening feasibility and the prevalence of positive proteinuria, as a marker for AA amyloidosis, among PWID accessing drug treatment services. AA amyloidosis is a serious, yet under-recognised condition for which early intervention is available but not employed.
Highlights
Skin and soft tissue infections (SSTIs) are a leading cause of morbidity and mortality among people who inject drugs (PWID)
Complications associated with delayed SSTI care include sepsis, gangrene, endocarditis, chronic venous ulcers and amyloid A (AA) amyloidosis— potentiating surgical debridement, limb amputation, renal failure and death [6, 13, 16,17,18,19]
In the UK context where AA amyloidosis risk is not screened for, most PWID are referred to specialist assessment after renal failure is discovered
Summary
Skin and soft tissue infections (SSTIs) are a leading cause of morbidity and mortality among people who inject drugs (PWID). Skin and soft tissue infections (SSTIs) are a preventable cause of morbidity and mortality among people who inject drugs (PWID) [1, 2]. In the UK, 36% of PWID report a recent symptom of a bacterial infection [11], with 10% admitted to hospital with SSTI complications annually [7]. Most of these hospitalisations are avoidable and are often due to delays in primary care access [7, 12, 13]. Economic implications are substantive; costs to the US health care system were approximately US$193 million in 2001 and costs to the UK health care system were assessed to be approximately £77 million per annum between July 2005 and July 2009 in 2012 [8]
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