Mitigating the Outcomes Associated with the Injection Drug Use Epidemic in Southern Appalachia

减轻阿巴拉契亚南部注射吸毒流行病的相关后果

基本信息

批准号：
9760233
负责人：
WILLIAM A ZULE
金额：
$ 82.46万
依托单位：
RESEARCH TRIANGLE INSTITUTE
依托单位国家：
美国
项目类别：
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/9760233
关键词：
Acute Hepatitis C Address Adherence Affect Alcohol or Other Drugs use Appalachian Region Attitude Awareness Behavioral Blood Volume Caring Centers for Disease Control and Prevention (U.S.)Cessation of life Characteristics Chronic Hepatitis C Clinic Communicable Diseases Communities Community based prevention Comorbidity Computerized Medical Record Continuing Education County Coupled Data Reporting Disease Outbreaks Disease Outcome Drug usage Effectiveness Emergency Situation Epidemic Epidemiologic Monitoring Funding HCV screening HIV Harm Reduction Health Health Personnel Health Professional Health Resources Health Services Accessibility Hepatitis C Hepatitis C Therapy Hepatitis C virus Heroin Human Resources Human immunodeficiency virus test Incentives Individual Infrastructure Injecting drug user Injections Institutional Review Boards International Interview Knowledge Law Enforcement Link Medical Morbidity - disease rate Movement Needle-Exchange Programs North Carolina Opioid Outcome Participant Patient Self-Report Pattern Pharmaceutical Preparations Pharmacy facility Phase Positioning Attribute Prevention Primary Health Care Professional counselor Provider Public Health Randomized Residual state Respondent Risk Risk Behaviors Rural Rural Community Rural Health Sampling Secure Services Social Work Source Substance Use Disorder Surveys Syringes System Telephone Test Result Testing Time Training Training Support Unemployment United States United States Dept. of Health and Human Services Universities adverse outcome behavioral health combat disorder risk follow-up health training injection drug use innovation insight meetings member mortality opioid injection opioid overdose opioid use outreach practice setting programs recruit response rural area rural counties scale up screening guidelines success surveillance data telehealth treatment program urgent care

项目摘要

Acute hepatitis C virus (HCV) infections in North Carolina increased 228% and heroin-related deaths increased 884% between 2010 and 2015. The NC Department of Health and Human Services (DHHS) conducted a vulnerability assessment and identified eight rural western counties with high rates of acute HCV, chronic HCV, and opioid overdose fatalities. RTI International, the University of NC at Chapel Hill, NC DHHS, local health departments (LHD), and the NC Harm Reduction Coalition are partnering in response to the RFA “HIV, HCV and Related Comorbidities in Rural Communities Affected by Opioid Injection Drug Epidemics in the United States: Building Systems for Prevention, Treatment and Control.” Our team is ideally positioned in NC to develop, implement, and evaluate sustainable strategies for combatting opioid-associated adverse outcomes in rural people who inject drugs (PWID). The specific aims of the project by UG3/UH3 phase are as follows: UG3–1. Conduct 80 (10 per county) semistructured interviews with PWID; begin recruiting PWID using respondent-driven sampling (n=400) and LHDs and syringe service programs (SSPs; n=200); and use baseline self-reported data and HCV and HIV testing results to describe the care cascade for HCV, HIV, and substance use disorders. UG3–2. Survey (mail, electronic and telephone; n=150) LHD personnel, primary care, emergency/urgent care, and behavioral health care professionals (HCPs) in all eight counties to assess practice characteristics; awareness of and adherence to substance use, HCV, and HIV screening guidelines; and attitudes regarding implementation of SSPs, HCV care, and HIV care across practice settings. Conduct meetings with a subset of stakeholders. UG3–3. Informed by participants, identify health centers serving PWID in Jackson and Haywood counties, randomize implementation order, and train providers on prevention and treatment of HCV, HIV, and opioid overdoses. Assessing knowledge and practice patterns at baseline and 18 months after training (incentivized with continuing education units) will allow us to gauge training impact. After successful completion of UG3 activities, we will pursue the following aims in the UH3 phase: UH3–1. Complete PWID recruitment, conduct 6- and 12-month follow-up interviews to assess changes in substance use; sexual and injection risk behaviors; HCV and HIV testing; movement through the HCV and HIV care cascade; and utilization of new and expanded services, including SSPs and bridge counselors. UH3–2. Deploy electronic medical record-driven screening for HCV, HIV, and substance use; telehealth support for HCV and HIV treatment; and booster training to optimize services in our pilot clinic(s). Using this as a template, we will recruit, train, and optimize 2–3 additional local clinics to expand regional care access. UH3–3. Using follow-up LHD and HCP surveys in Year 5, epidemiological surveillance, and data on PWID linked to services by bridge counselors and providers trained, we will assess the impact on each care cascade and disseminate findings to local and state partners.

北卡罗来纳州急性丙型肝炎病毒 (HCV) 感染增加 228%，海洛因相关死亡人数增加 2010 年至 2015 年间为 884%。北卡罗来纳州卫生与公众服务部 (DHHS) 进行了一项脆弱性评估并确定了八个西部农村县急性丙型肝炎、慢性丙型肝炎、以及阿片类药物过量死亡事件、RTI International、北卡罗来纳大学教堂山分校、北卡罗来纳州 DHHS、当地卫生部门。各部门 (LHD) 和北卡罗来纳州减害联盟正在合作响应 RFA“HIV、HCV 美国受阿片类注射毒品流行影响的农村社区的相关合并症州：建立预防、治疗和控制系统。” 制定、实施和评估可持续战略，以对抗阿片类药物相关不良后果 UG3/UH3 阶段的农村注射吸毒者 (PWID) 的具体目标如下： UG3-1. 对注射吸毒者进行 80 次（每个县 10 次）半结构化访谈；开始招募注射吸毒者报告者驱动的采样（n=400）以及 LHD 和注射器服务计划（SSP；n=200）和使用；基线自我报告数据以及 HCV 和 HIV 检测结果，以描述 HCV、HIV 和 HIV 的护理级联物质使用障碍调查（邮件、电子和电话；n=150）LHD 人员，初级。对所有八个县的护理、紧急/紧急护理和行为健康护理专业人员 (HCP) 进行评估实践特征；对药物使用、丙型肝炎病毒和艾滋病毒筛查指南的认识和遵守；对跨实践环境实施 SSP、HCV 护理和 HIV 护理的态度。与一部分利益相关者举行会议，由参与者告知，确定为注射吸毒者提供服务的卫生中心。在杰克逊县和海伍德县，随机安排实施顺序，并对提供者进行预防和培训 HCV、HIV 和阿片类药物过量的治疗评估基线和 18 的知识和实践模式。培训后的几个月（通过继续教育单元进行激励）将使我们能够评估培训后的影响。成功完成 UG3 活动后，我们将在 UH3 阶段追求以下目标：UH3-1。完成注射吸毒者招募，进行 6 个月和 12 个月的后续访谈，以评估实质变化使用；性行为和注射危险行为；通过 HCV 和 HIV 护理进行 HCV 和 HIV 检测；级联；以及利用新的和扩展的服务，包括 SSP 和桥梁顾问。电子病历驱动的 HCV、HIV 筛查以及 HCV 和药物使用的远程医疗支持；艾滋病毒治疗；以及加强培训，以优化我们试点诊所的服务，我们将以此为模板。招募、培训和优化另外 2-3 个当地诊所，以扩大地区医疗服务的覆盖范围。第 5 年的 LHD 和 HCP 调查、流行病学监测以及通过桥梁与服务相关的吸毒者数据经过培训的顾问和提供者，我们将评估对每个护理级联的影响并将调查结果传播给地方和州合作伙伴。