The effect of opioids, stimulants, and the simultaneous use of both on the hepatitis C virus (HCV) cascade of care in rural communities in the United States

阿片类药物、兴奋剂以及同时使用两者对美国农村社区丙型肝炎病毒 (HCV) 级联护理的影响

• 批准号: 10459753
• 负责人: Angela T Estadt
• 金额: $ 4.06万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-03 至 2025-05-02
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10459753
• 关键词: Abstinence; Acute Hepatitis C; Affect; Amphetamines; Area; Caring; Clinical; Cocaine; Collaborations; Communicable Diseases; Communities; Counseling; Data; Data Collection; Disease Surveillance; Drug user; Education; Epidemic; Epidemiologic Methods; Epidemiology; Equilibrium; Faculty; Foundations; Funding; Geographic Information Systems; Geographic Locations; Geography; Growth; HCV screening; Health Personnel; Health Services Accessibility; Hepatitis C; Hepatitis C Therapy; Hepatitis C Transmission; Hepatitis C virus; Illinois; Incidence; Infrastructure; Injecting drug user; Injections; Kentucky; Location; Measures; Methamphetamine; Methods; Morbidity - disease rate; National Institute of Drug Abuse; Needle Sharing; Needle-Exchange Programs; Needs Assessment; Neurologic Effect; New England; North Carolina; Ohio; Opioid; Oregon; Outcome; Persons; Pharmaceutical Preparations; Population; Prevalence; Public Health; Public Health Informatics; Recording of previous events; Reporting; Research; Research Personnel; Resources; Risk; Risk Behaviors; Rural; Rural Community; Rural Population; Services; Stimulant; Substance Use Disorder; Testing; United States; United States National Institutes of Health; West Virginia; Wisconsin; Work; amphetamine use; base; behavioral health; career; cocaine use; data integration; demographics; epidemiology study; evidence base; experience; gaps in access; geographic population; improved; injection drug use; methamphetamine use; mortality; opioid use; opioid use disorder; polysubstance use; population health; programs; response; rural area; screening; spatial epidemiology; stimulant use; substance use; substance use treatment; tool; treatment adherence; treatment services; urban area; virus resource

PROJECT SUMMARY The number of acute hepatitis C virus (HCV) infections has risen steadily in the U.S. due to increased injection drug use (IDU). The growth of IDU has disproportionately contributed to acute HCV infections in rural communities as their incidence rates are more than twice those of urban areas. HCV management is described using the HCV cascade of care (CoC) and includes testing and treatment completion. There is a critical need to increase HCV testing among people who inject drugs (PWID). The annual HCV testing rate is only 7.7% among those clinically identified as PWID in the U.S. Among rural PWID who tested positive for HCV, 59% contacted a healthcare provider within 18 months of their results, 14% reported seeking HCV treatment, and only 8% reported receiving HCV treatment. Further, stimulant use, defined as methamphetamine, amphetamine, or cocaine use, is resurging. Polysubstance use of opioids and stimulants is increasing among rural PWID and is associated with increased factors for HCV transmission, such as syringe sharing. Yet, the effect of stimulant and polysubstance use on HCV testing and treatment remains unclear. The proposed research aims to reduce the morbidity and mortality associated with HCV among PWID in rural communities. The proposed project will leverage data collected in eight NIH-funded studies of the Rural Opioid Initiative (ROI) (NIDA U24DA048538). We will use this comprehensive collection of data and the integration of epidemiological and spatial methods to determine the effect of opioids, stimulants (methamphetamine, amphetamine, cocaine), and their simultaneous and concurrent use on HCV infection, testing, and treatment completion in rural communities included in the ROI infrastructure. Aim 1 will estimate the association of opioid use, stimulant use, and polysubstance use of opioids and stimulants with the presence of HCV infection among PWID. Aim 2 will measure the association of opioid, stimulant, and polysubstance (opioid and stimulant) use on HCV testing and treatment completion. Aim 3 will identify high-priority locations to target HCV testing and treatment among PWID communities within the ROI infrastructure. The results from this project will identify rural communities that require HCV testing and treatment support to curtail the spread of HCV and associated mortalities among PWID. This project will enhance the applicant’s expertise and application of epidemiological methods to solve public health issues in the fields of substance use and infectious diseases. The applicant will gain research, collaboration, and dissemination experience to prepare her for an independent epidemiological investigator career. This project and applicant are supported by distinguished faculty in epidemiology, substance use, infectious diseases, behavioral health, geography, population health, and public health informatics.

项目概要 由于注射增加，美国急性丙型肝炎病毒（HCV）感染人数稳步上升 吸毒 (IDU) 的增长对农村地区的急性丙肝病毒感染造成了不成比例的影响。 社区的 HCV 发病率是城市地区的两倍以上。 使用 HCV 级联护理 (CoC)，包括检测和完成治疗 迫切需要。 增加注射吸毒者 (PWID) 的 HCV 检测 年度 HCV 检测率仅为 7.7%。 在美国临床上确定为吸毒者的人群中，HCV 检测呈阳性的农村吸毒者中，59% 在获得结果后 18 个月内联系了医疗保健提供者，14% 的人报告寻求 HCV 治疗，并且 只有 8% 的人报告接受了 HCV 治疗。 此外，使用兴奋剂（定义为甲基苯丙胺）。 安非他明或可卡因的使用正在重新流行，阿片类药物和兴奋剂的使用正在增加。 农村吸毒者与丙型肝炎病毒传播的增加因素有关，例如共用注射器。 兴奋剂和多种物质的使用对 HCV 检测和治疗的影响仍不清楚。 研究旨在降低农村社区吸毒者中与丙型肝炎相关的发病率和死亡率。 拟议的项目将利用 NIH 资助的农村阿片类药物倡议的八项研究中收集的数据 （ROI）（NIDA U24DA048538）我们将使用这种全面的数据收集和整合。 流行病学和空间方法来确定阿片类药物、兴奋剂（甲基苯丙胺、 安非他明、可卡因）及其在 HCV 感染、检测和治疗中的同时使用 ROI 基础设施中包含的农村社区的完成情况将估计阿片类药物的关联。 存在 HCV 感染的阿片类药物和兴奋剂的使用、兴奋剂使用和多物质使用 PWID 目标 2 将衡量阿片类药物、兴奋剂和多物质（阿片类药物和兴奋剂）使用的关联。 目标 3 将确定 HCV 检测和治疗的高优先级地点。 该项目的结果将确定 ROI 基础设施内注射吸毒者社区的治疗情况。 需要丙肝病毒检测和治疗支持以遏制丙肝病毒及相关疾病传播的农村社区 该项目将提高申请人的流行病学专业知识和应用。 申请人将解决物质使用和传染病领域的公共卫生问题的方法。 获得研究、合作和传播经验，为独立的流行病学研究做好准备 该项目和申请人得到了流行病学领域杰出教师的支持， 物质使用、传染病、行为健康、地理、人口健康和公共卫生 信息学。