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.

北卡罗来纳州的急性丙型肝炎病毒（HCV）感染增加了228％，海洛因相关死亡增加了 2010年至2015年之间的884％。北卡罗来纳州卫生与公共服务部（DHHS）进行了脆弱性评估，并确定了八个急性HCV发生率高的西方县，慢性HCV，和阿片类药物过量死亡。 RTI International，北卡罗来纳州北卡罗来纳州北卡罗来纳州DHHS的北卡罗来纳大学，当地健康部门（LHD）和NC减少危害联盟正在响应RFA“ HIV，HCV）合作以及由阿片类药物注入药物流行病影响的农村社区的相关合并症国家：预防，治疗和控制的建筑系统。制定，实施和评估可持续策略，以打击与阿片类药物相关的广告结果注射毒品的农村人士（PWID）。 UG3/UH3阶段的项目的具体目的如下： UG3–1。对PWID进行80个半结构化访谈；开始使用PWID招募PWID 响应驱动的采样（n = 400）和LHD和注射器服务程序（SSP; n = 200）;并使用基线自我报告的数据以及HCV和HIV测试结果，以描述HCV，HIV和HIV的护理级联物质使用障碍。 UG3–2。调查（邮件，电子和电话； n = 150）LHD人员，主要所有八个县的护理，紧急/紧急护理和行为医疗保健专业人员（HCP）评估练习特征；意识和遵守物质使用，HCV和HIV筛查指南；并参加有关在实践环境中实施SSP，HCV护理和艾滋病毒护理的有关实施的活动。执行与利益相关者的子集会议。 UG3–3。由参与者告知，确定为PWID服务的健康中心在杰克逊（Jackson）和海伍德（Haywood）县，随机实施订单，并在预防和 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（通过继续教育单位激励）将使我们能够衡量培训的影响。后成功完成UG3活动，我们将在UH3阶段实现以下目标：UH3-1。完整的PWID招聘，进行6个月和12个月的随访访谈，以评估底物的变化使用;性和注射风险行为； HCV和HIV测试；通过HCV和HIV护理运动级联;并利用新的和扩展的服务，包括SSP和Bridge Coinsellors。 UH3–2。部署电子病历驱动的HCV，HIV和药物使用筛查；远程医疗支持HCV和艾滋病毒治疗；以及在我们的飞行员诊所优化服务的助推器培训。将其用作模板，我们将招募，训练和优化2-3个其他当地诊所，以扩大区域护理。 UH3–3。使用后续 LHD和HCP监视5年级，流行病学监视以及有关桥梁服务的PWID数据培训的计数和提供者，我们将评估对每个护理级联的影响，并将调查结果传播给本地和国家合作伙伴。