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 大流行使各城镇持续存在的住房危机变得更加严峻，造成前所未有的 无家可归者人数众多，导致不稳定、集中的无家可归者健康状况不佳 在马萨诸塞州波士顿，2021 年 10 月发布了公共卫生紧急状态声明。 2022 年 1 月大规模搬迁活动，将 200 多人从大型街道营地转移到 5 个营地 新颖的“减少伤害住房”（HRH）计划该地区因其靠近地区医院而闻名。 露天毒品市场以及与毒品和犯罪有关的暴力行为。 获得减少伤害的用品，如无菌注射器和其他更安全使用的材料、纳洛酮和低屏障 药物治疗，工作人员根据倡导以下原则的政策提供这些服务 “在人们所在的地方与他们会面”，但 HRH 网站的不同方式可能会影响居民的结果，以及 数据表明，住房干预措施可能会加剧隔离，从而加剧隔离。 其他人则声称，由于药物的改善，生命将被挽救，救生治疗将开始 对最近搬迁的人员进行的初步病例交叉分析反映了不同的情况。 缺乏明确的、科学严谨的流程来考虑预期的影响。 以及这些行为的意外后果，我们提出了一项快速、混合的方法研究，以有效地检查 搬迁工作的直接影响以及居住在新的HRH 中的长期影响。 具体来说，这项时间敏感的研究将从社区收集调查、访谈和药品供应数据 波士顿集中地区无家可归和吸毒的人受到这些影响 该研究将有助于确定以下方面的短期和长期影响： a) 快速搬迁以及如何搬迁。 居民成功地度过了难关；以及 b) 共同为个人提供减少伤害服务和住房—— 具体目标是： 目标 1) 制定危害衡量标准。 减少服务和政策，以清点其在 HRH 站点中的提供和使用情况，以研究连续性， 目标 2) 招募一个观察队列，跟踪 100 名 HRH 居民，共 12 人。 几个月来对搬迁影响进行分类，并了解减少伤害服务的使用如何改变吸毒、艾滋病毒 新 HRH 居民队列的药物风险行为、治疗接受情况和当地药物供应数据。 成员将加强我们之前对搬迁影响的案例交叉分析。目标 3) 进行重复、 对 25 名队列成员进行纵向一对一访谈，以更深入地了解 搬迁和殿下居住，包括健康和安全影响、集体效能的变化和性别 调查结果将有助于减少危害科学，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，并规划公共 针对住房搬迁或灾害应对的健康导向缓解计划。