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: 10675446
• 负责人: Angela T Estadt
• 金额: $ 1.14万
• 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 2023-05-07
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10675446
• 关键词: Abstinence; Acute Hepatitis C; Affect; Amphetamines; Area; Caring; Clinical; Cocaine; Collaborations; Communicable Diseases; Communities; Counseling; Data; Data Collection; Disease Surveillance; Disparity; 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 Prevalence; Hepatitis C Therapy; Hepatitis C Transmission; Hepatitis C virus; Heroin; 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; Recommendation; 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; behavioral health; career; cocaine use; demographics; epidemic virus; epidemiology study; evidence base; experience; gaps in access; 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; Abstinence; Acute Hepatitis C; Affect; Amphetamines; Area; Caring; Clinical; Cocaine; Collaborations; Communicable Diseases; Communities; Counseling; Data; Data Collection; Disease Surveillance; Disparity; 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 Prevalence; Hepatitis C Therapy; Hepatitis C Transmission; Hepatitis C virus; Heroin; 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; Recommendation; 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; behavioral health; career; cocaine use; demographics; epidemic virus; epidemiology study; evidence base; experience; gaps in access; 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.

项目摘要 由于注射增加，美国的急性肝炎病毒（HCV）感染的数量在美国稳步增加 吸毒（IDU）。 IDU的生长不成比例地导致农村急性HCV感染 社区作为事件率是城市地区的两倍以上。描述了HCV管理 使用HCV护理级联（COC），包括测试和治疗完成。有急需 增加注射药物（PWID）的人的HCV测试。年度HCV测试率仅为7.7％ 在美国在临床上被识别为PWID的临床识别，在对HCV呈阳性的粗糙PWID中，59％ 在结果后的18个月内与医疗保健提供者联系，有14％的人报告寻求HCV治疗，并 只有8％的人报告接受HCV治疗。此外，刺激性使用，定义为甲基苯丙胺， 苯丙胺或可卡因的使用正在恢复。阿片类药物和刺激剂的多刺激使用量正在增加 农村PWID，与HCV传播的因素增加有关，例如注射器共享。但是， 刺激性和多肌固定对HCV测试和治疗的影响尚不清楚。提议 研究旨在降低粗糙社区PWID中与HCV相关的发病率和死亡率。 拟议的项目将利用八项对农村阿片类药物倡议的NIH资助的研究收集的数据 （ROI）（NIDA U24DA048538）。我们将使用这种全面的数据集和集成 流行病学和空间方法来确定阿片类药物，兴奋剂的作用（甲基苯丙胺，， 苯丙胺，可卡因）及其在HCV感染，测试和治疗中的同时且同时使用 ROI基础设施中包括的粗糙社区完成。 AIM 1将估计Ooid的关联 使用，兴奋剂使用和多刺激使用阿片类药物和兴奋剂，并在HCV感染中存在 PWID。 AIM 2将测量阿片类药物，兴奋剂和多刺激剂（阿片类药物和兴奋剂）的缔合 关于HCV测试和治疗完成。 AIM 3将确定针对HCV测试的高优先级位置和 ROI基础设施中的PWID社区之间的治疗。该项目的结果将确定 需要HCV测试和治疗支持的粗糙社区，以限制HCV的传播和相关性 PWID之间的死亡。该项目将增强应用程序的专业知识和流行病学的应用 在物质使用和传染病领域解决公共卫生问题的方法。申请人将 获得研究，协作和传播经验，为她准备独立流行病学 调查员职业。该项目和适用的流行病学教师支持 药物使用，传染病，行为健康，地理，人口健康和公共卫生 信息。