Kentucky Communities and Researchers Engaging to Halt the Opioid Epidemic (CARE2HOPE)

肯塔基州社区和研究人员致力于制止阿片类药物的流行 (CARE2HOPE)

• 批准号: 9760236
• 负责人: Hannah LF Cooper
• 金额: $ 149.93万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-15 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9760236
• 关键词: Address; Appalachian Region; Area; Behavioral; Caring; Centers for Disease Control and Prevention (U.S.); Cities; Coal; Collaborations; Communities; Community Trial; Country; County; Disease Outbreaks; Drug user; Effectiveness; Elements; Ensure; Environment; Epidemic; Epidemiologic Methods; Epidemiology; Evidence based intervention; General Population; HIV; HIV/HCV; Harm Reduction; Health; Health Services; Hepatitis C virus; Heroin; Incidence; Infrastructure; Injecting drug user; Injections; Intervention; Kentucky; Knowledge; Laws; Letters; Methods; Modeling; Naloxone; National Institute of Drug Abuse; Needle-Exchange Programs; Outcome; Overdose; Pathway Analysis; Pharmaceutical Preparations; Phylogenetic Analysis; Plant Roots; Policies; Prescription opioid overdose; Provider; Public Health; Qualitative Research; Readiness; Research Infrastructure; Research Personnel; Resources; Risk; Risk Assessment; Rivers; Rural; Rural Appalachia; Services; Site; Substance Use Disorder; Testing; United States Substance Abuse and Mental Health Services Administration; Unsafe Sex; Work; base; combat; community based participatory research; cost effectiveness; data exchange; design; evidence base; implementation science; improved; infectious disease treatment; injection drug use; innovation; mathematical model; member; misuse of prescription only drugs; opioid epidemic; opioid injection; prescription opioid; randomized trial; response; rural counties; social stigma; theories; virtual

Abstract: The proposed project will build evidence-based, community-rooted public health responses to the epidemics of non-medical prescription opioid (NMPO) and heroin injecting, overdoses (ODs), and HCV, and to imminent HIV outbreaks, in 12 rural Appalachian Kentucky counties at the epicenter of these intertwined national crises. 10 counties rank in the top 5% for HIV/HCV vulnerability. Rates of HCV, injection drug use (IDU), and ODs are high in these counties, and most are in coal country, an RFA priority. Unfortunately, these counties exemplify an extreme version of the “implementation chasm,” a chasm dividing scientific knowledge from action. Evidence-based public health responses to these epidemics exist (e.g., syringe service programs [SSPs]) and are often deployed in cities. In these 12 rural counties, though, scarcities of resources and of providers conspire with drug-related stigma to constrain public health responses. The counties' public health infrastructures are weak, their harm reduction infrastructures virtually non-existent. This project will bridge the implementation chasm in these 12 counties, and recognizes that bridging this chasm requires more than simply importing SSPs and other evidence-based community response projects (EB-CRPs) from cities. Guided by harm reduction principles, the Risk Environment Model, and Community/ Academic Partnerships (CAPs), in the UG3 we will: (1) Assess and enhance each county's readiness to improve the local risk environment. (2) Examine the strengths, resources, needs, and gaps of each county's risk environment. We will conduct a multi-method Community Assessment of the Risk Environment that integrates innovative, rigorous epidemiology (e.g., modeling); policy assessment; and best practices in community-based research (e.g., CAPs). (3) Select a package of EB-CRPs that responds to local needs and strengths, using elements of Intervention Mapping. Go/no go milestone: Each CAP will have created an EB- CRP package that (1) addresses targets common across all counties (e.g., opioid injection, OD, HCV, HIV), and (2) is tailored to local needs, resources, and readiness. In the UH3, we will: (4) Tailor selected EB-CRPs to each county's context using ADAPT-ITT. (5) Analyze the effectiveness and cost-effectiveness of each county's EB-CRP package, using an innovative stepped-wedge community randomized trial and mathematical models. We will use continuous quality improvement to enhance each EB-CRP's fidelity, reach, immediate effects, and outcomes. To inform interventions, advanced network analyses will overlay risk networks with GHOST phylogenetic transmission data to show where HCV has been and predict where it is going. We draw strength from our collaborations. CAPs will meld residents' local knowledge with researchers' scientific expertise. Multi- PIs Young and Cooper have assembled an academic team with unsurpassed expertise in key substance, theories, and methods, and in multisite studies. The combination of a rigorous, innovative design (e.g., step- wedge community trials), strong theories, and a stellar team with community roots will ensure high impact.

摘要：拟议项目将建立基于证据、植根于社区的公共卫生应对措施 非医疗处方阿片类药物 (NMPO) 和海洛因注射、过量 (OD) 和丙型肝炎病毒的流行， 肯塔基州阿巴拉契亚山脉 12 个农村县的艾滋病毒疫情即将爆发，这些县相互交织 10 个县的 HIV/HCV 易感性、注射吸毒率排名前 5%。 (IDU)，这些县的 OD 很高，而且大多数位于煤炭国家，这是 RFA 的优先事项。 不幸的是，这些县体现了“执行鸿沟”的极端版本 针对这些流行病的基于证据的公共卫生对策存在着分歧。 （例如，注射器服务计划 [SSP]）并且经常部署在这 12 个农村县中。 资源和提供者的稀缺与毒品相关的耻辱相结合，限制了公共卫生应对措施。 这些县的公共卫生基础设施薄弱，减少危害的基础设施几乎不存在。 该项目将弥合这 12 个县的实施鸿沟，并认识到弥合这一问题 鸿沟需要的不仅仅是导入 SSP 和其他基于证据的社区应对项目 (EB-CRP) 来自城市，以减少危害原则、风险环境模型和社区/为指导。 学术合作伙伴关系 (CAP)，在 UG3 中，我们将： (1) 评估并加强每个县的准备情况 (2) 检查各县的优势、资源、需求和差距 我们将对风险环境进行多方法社区评估。 整合创新、严格的流行病学（例如建模）和最佳实践； 基于社区的研究（例如 CAP） (3) 选择响应当地需求的一揽子 EB-CRP。 优势，使用干预映射的元素进行/不进行里程碑：每个 CAP 将创建一个 EB-。 CRP 方案 (1) 解决所有县的共同目标（例如阿片类药物注射、OD、HCV、HIV）， (2) 根据当地需求、资源和准备情况量身定制 在 UH3 中，我们将： (4) 根据需要定制选定的 EB-CRP。 使用 ADAPT-ITT 分析每个县的具体情况 (5) 分析每个县的有效性和成本效益。 EB-CRP 包，采用创新的阶梯式楔形社区随机试验和数学模型。 我们将通过持续的质量改进来提高每个 EB-CRP 的保真度、覆盖面、即时效果和 为了为干预措施提供信息，高级网络分析将用 GHOST 覆盖风险网络。 我们利用系统发育传播数据来显示 HCV 的去向并预测其去向。 我们的合作将居民的当地知识与研究人员的科学专业知识融为一体。 PI Young 和 Cooper 组建了一支学术团队，在关键物质、 理论、方法和多地点研究的结合。 楔形社区试验）、强大的理论和具有社区根基的一流团队将确保产生巨大影响。