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：拟议的项目将建立基于循证的，社区根基的公共卫生反应 非医学处方阿片类药物（NMPO）和海洛因注射，过量（ODS）和HCV的流行病，以及 即将到来 国家危机。 10个县在HIV/HCV漏洞中排名前5％。 HCV，注射药物使用率 （IDU），并且在这些县中的OD较高，并且大多数位于煤炭国家，是RFA的优先事项。 不幸的是，这些县举例说明了“实施鸿沟”的极端版本 将科学知识与行动分开。基于证据的公共卫生对这些流行病的反应 （例如，注射器服务程序[SSP]），经常部署在城市中。但是，在这12个农村县中 资源和提供者的稀缺性与毒品有关的污名共识，以限制公共卫生的反应。 县的公共卫生基础设施薄弱，其减少危害基础设施实际上不存在。 该项目将弥合这12个县的实施鸿沟，并认识到这一点 CHASM不仅需要简单地进口SSP和其他基于证据的社区响应项目 （EB-Crps）来自城市。以减少伤害原则，风险环境模型和社区/的指导 学术合作伙伴关系（上限），在UG3中：（1）评估和增强每个县的准备就绪 改善当地风险环境。 （2）检查每个县的优势，资源，需求和差距 风险环境。我们将对风险环境进行多方法社区评估 综合创新，严格的流行病学（例如建模）；政策评估；以及最佳实践 基于社区的研究（例如CAPS）。 （3）选择一个响应本地需求的EB-CRP包和 优势，使用干预映射的要素。 GO/NO GO MILESTONE：每个帽子都会创建一个EB- CRP软件包（1）解决了所有县（例如阿片类药物注入，OD，HCV，HIV）的共同目标， （2）是根据当地需求，资源和准备就绪量身定制的。在UH3中，我们将：（4）量身定制选定的EB-CRP 每个县的上下文使用Adapt-Itt。 （5）分析每个县的有效性和成本效益 EB-CRP软件包，使用创新的跨越跨越社区的随机试验和数学模型。 我们将使用持续的质量改进来增强每个EB-CRP的忠诚度，覆盖范围，直接效果和 结果。为了告知干预措施，高级网络分析将覆盖风险网络 系统发育传播数据显示了HCV的位置并预测其前进的位置。我们汲取力量 从我们的合作。 CAPS将与研究人员的科学专业知识融合居民的当地知识。多- PIS Young和Cooper召集了一个学术团队，具有无与伦比的关键物质专业知识， 理论，方法以及多站点研究。严格，创新设计的结合（例如 楔形社区试验），强大的理论和具有社区根源的出色团队将确保高影响力。