Rapid measurement of novel harm reduction housing on HIV risk, treatment uptake, drug use and supply

快速测量新型减害住房对艾滋病毒风险、治疗接受情况、毒品使用和供应的影响

• 批准号: 10701309
• 负责人: TRACI C GREEN
• 金额: $ 26.33万
• 依托单位: BRANDEIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10701309
• 关键词: Abstinence; Acute Hepatitis; Address; Affect; Air; Area; Behavior; Boston; COVID-19 pandemic; Caring; Catalogs; Cause of Death; Cities; Communicable Diseases; Communities; Contracts; Crime; Data; Data Set; Disasters; Disease Outbreaks; Drug abuse; Drug usage; Enrollment; Environment; Epidemiology; Equipment and supply inventories; Evolution; Exposure to; Fentanyl; Gender; Goals; HIV; HIV risk; Harm Reduction; Health; Hepatitis A Virus; Homeless persons; Homelessness; Hospitals; Housing; Illicit Drugs; Improve Access; Individual; Infection; Injections; Intervention; Interview; Leadership; Learning; Life; Link; Massachusetts; Measurement; Measures; Methods; Naloxone; Natural experiment; Outcome; Overdose; Patterns of Care; Persons; Pharmaceutical Preparations; Policies; Positioning Attribute; Process; Prophylactic treatment; Public Health; Public Housing; Research; Research Support; Risk; Risk Behaviors; Role; SARS-CoV-2 infection; Safety; Science; Seasons; Service provision; Services; Site; Social isolation; Social outcome; Sterility; Structure; Surveys; Syringes; Time; United States; Violence; Work; addiction; cohort; coronavirus disease; drug market; experience; health care service; improved outcome; insight; meetings; member; multidisciplinary; novel; overdose risk; peer; peer support; pre-exposure prophylaxis; prevention service; programs; public health emergency; residence; response; risk mitigation; service uptake; social; social cohesion; social health determinants; statistics; success; supported housing; syndemic; transitional housing; uptake

The COVID-19 pandemic has strained an ongoing housing crisis across cities and towns, leaving unprecedented numbers of people homeless and creating poor health conditions in precarious, concentrated homeless encampments. In Boston, Massachusetts, an October 2021 public health emergency declaration preceded a January 2022 massive relocation campaign that moved over 200 people from a large street encampment into 5 novel “harm reduction housing” (HRH) programs. The area is known for its proximity to area hospitals, its open-air drug market, and violence related to drugs and crime. These programs provide housing units with access to harm reduction supplies like sterile syringes and other safer use materials, naloxone, and low-barrier medication treatment, and staff provide these services according to policies that champion the principles of “meeting people where they are”. But the HRH sites differ in ways that may affect resident outcomes, and uptake of services vary. Data suggest that housing interventions may tragically increase isolation and thus overdose risk; others claim lives will be saved and life-saving treatments will start because of their improved access at the HRH sites. An initial case-crossover analysis of those recently relocated echoed a mixture of positive and negative effects. Lacking clear-cut, scientifically rigorous processes that consider both intended and unintended consequences of these actions, we propose a rapid, mixed methods study to efficiently examine the immediate effects of the relocation efforts and the longer-term impacts of living in the novel HRH. Specifically, this time-sensitive study will collect survey, interview, and drug supply data from the community of people who are homeless and use drugs in the concentrated area of Boston who have been affected by these recent actions. The study will help to determine short and long-term impacts of: a) rapid relocation and how residents successfully navigated it; and b) co-provision of harm reduction services and housing on individual- level behaviors and local drug supply outcomes. Specific aims are to: Aim 1) Develop a measure of harm reduction services and policies to inventory their provision and use in HRH sites for studying continuity, uptake, and evolution of care. Aim 2) Enroll an observational cohort following 100 HRH residents for 12 months to catalogue relocation effects and understand how harm reduction services use changes drug use, HIV and drug risk behaviors, treatment uptake, and the local drug supply. Data specific to new HRH resident cohort members will augment our prior case-crossover analysis of relocation impacts. Aim 3) Conduct repeat, longitudinal one-on-one interviews with 25 cohort members to gain greater insight into the nuances of relocation and HRH residence, including health and safety impacts, changes in collective efficacy, and gender considerations. Findings will contribute to harm reduction science and will be directly relevant to jurisdictions considering HRH, adapting housing contracts to incorporate harm reduction services, and planning public health-directed mitigation plans for housing relocations or disaster responses.

COVID-19大流行使整个城市和城镇中的住房危机都陷入了困境，留下了前所未有的 人数无家可归，并在不稳定的，集中的无家可归者中创造不良的健康状况 营地。 2021年10月，在马萨诸塞州波士顿，公共卫生紧急宣言。 2022年1月，大规模搬迁运动将200多人从大街营地转移到5 新颖的“减少危害住房”（HRH）计划。该地区以其靠近地区医院的近处而闻名 露天药物市场以及与毒品和犯罪有关的暴力。这些计划为住房单位提供 获取危害减少供应供应，例如无菌注射器和其他安全使用材料，纳洛酮和低屏障 药物治疗，工作人员根据倡导原则的政策提供这些服务 “结识他们在哪里”。但是，HRH站点在可能影响居民结果的方式上有所不同，并且 服务的吸收各不相同。数据表明，住房干预措施可能会显着增加隔离，从而 过量的风险；其他人则声称生命将得到挽救，并因其改善而开始挽救生命的治疗 在HRH站点访问。对最近重新定位的人的初始案例分解分析回应了混合物的混合物 积极和负面影响。缺乏考虑两者意图的明确，科学严格的过程 以及这些行动的意外后果，我们提出了一项快速而混合的方法研究，以有效地检查 搬迁工作的直接影响以及在新型HRH中生活的长期影响。 具体而言，这项对时间敏感的研究将收集社区的调查，访谈和药物供应数据 在波士顿的集中地区无家可归并使用毒品的人中 最近的行动。该研究将有助于确定以下方面的短期和长期影响：a）快速搬迁以及如何 居民成功地导航了。 b）共同提供减少损害服务和个人住房 水平行为和当地药物供应结果。具体目的是：目标1）制定危害措施 减少服务和政策，以清点其在HRH站点进行连续性的提供和使用， 吸收和护理的演变。目标2）在100 hrh居民中招募一个观察队列12 几个月来分类搬迁效果并了解减少伤害服务的使用方式变化，艾滋病毒 以及药物风险行为，治疗摄取和当地药物供应。特定于新的HRH居民队列的数据 成员将扩大我们先前对搬迁影响的案件分解分析。目标3）进行重复， 纵向对25名队列成员进行一对一的访谈，以更深入地了解 搬迁和HRH住宅，包括健康和安全影响，集体效率的变化和性别 考虑因素。调查结果将有助于损害减少科学，并将与司法管辖区直接相关 考虑HRH，调整住房合同以纳入减少危害服务，并计划公众 卫生指导的缓解计划针对住房重新定位或灾难反应。