Expansion of Mail-Delivered Harm Reduction Services in the U.S.

扩大美国邮件递送减害服务

• 批准号: 10590378
• 负责人: Czarina Navos Behrends
• 金额: $ 239.34万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2025-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10590378
• 关键词: AIDS prevention; Acute; Address; Area; Black race; Blood; COVID-19; Client; Cohort Studies; Development; Disease; Disease Outbreaks; District of Columbia; Drug usage; Environment; Face; Fentanyl; Fright; Future; HIV/HCV; Harm Reduction; Health; Health Services; Hispanic; Home; Hour; Injecting drug user; Injections; Intervention; Interview; Investigation; Law Enforcement; Laws; Legal; Longitudinal cohort study; Modality; Naloxone; Needle-Exchange Programs; Online Systems; Overdose reversal; Participant; Perception; Persons; Pharmacy facility; Policies; Population; Public Health; Reporting; Risk; Risk Behaviors; Route; Rural; Sample Size; Secure; Services; Source; Surveys; Syringes; Taxonomy; Technology; Time; Transportation; Underserved Population; Woman; Youth; acceptability and feasibility; base; design; experimental study; follow-up; gaps in access; health care delivery; high risk; housing instability; improved; innovation; insight; meetings; opioid overdose; opioid use; overdose death; peer; preference; prevent; programs; recruit; scale up; secondary analysis; service delivery; service engagement; social media; social stigma; test strip; uptake

PROJECT SUMMARY COVID-19 has led to record high overdose deaths in the US and high risk for future injection-related HIV and hepatitis c (HCV) outbreaks. Innovative approaches are urgently needed to expand access to syringes and naloxone, a drug used for opioid overdose reversal, for the prevention of HIV/HCV outbreaks and opioid overdose fatalities. Expansion and scale-up of mail-based harm reduction services may address harm reduction access gaps by providing a more convenient and confidential way to obtain services. To inform scale-up these services, we aim to 1) describe policy barriers to national expansion of mail-based syringe services and fentanyl strip distribution, 2) conduct a national, longitudinal cohort study to examine predictors of uptake and long-term engagement in mail-based harm reduction services, and 3) assess the add-on harm reduction and health services preferences of mail delivery clients. For Aim 1, we will conduct a systematic legal review of relevant laws in each of the 50 states and the District of Columbia to determine whether and how state law may impact the legality of distributing syringes and fentanyl test strips by mail. We will develop a taxonomy of policies that may prevent legal expansion of mail-delivered syringes. To understand the perception of legal risks associated with mailing syringes among potential adopters, we will survey and interview 20 stakeholders (i.e., health departments and SSPs) from states representing different legal environments for mail-delivery. For Aim 2, we will build on a social media-recruited survey examining uptake and acceptability of mail-delivered harm reduction by expanding the follow up period of that survey from 6 months to 12 and 18 months and expanding the sample size of this survey. This will allow us to assess predictors of uptake and mail-delivered harm reduction engagement over the long-term in order to fully understand who uses mail-delivered services and how these services are being used over time. For Aim 3 we will design and implement discrete choice experiment (DCE) surveys to determine mail-based service client preferences for receiving add-on harm reduction and health services. These results will be disseminated to policy stakeholders, potential adopters, and NEXT affiliates to inform expansion and scale-up of mail-based harm reduction services, improve engagement with current NEXT users, and expand the type of services offered through these programs.

项目摘要 COVID-19导致美国创造了高用药死亡的高度过量死亡，并为未来注射相关的艾滋病毒和 丙型肝炎（HCV）暴发。迫切需要进行创新的方法来扩展对注射器的访问和 纳洛酮是一种用于预防HIV/HCV暴发和阿片类药物的阿片类药物过量逆转的药物 过量死亡。基于邮件的减少损害服务的扩展和规模可能解决危害 通过提供更便捷和机密的方法来获取服务来减少访问差距。告知 扩展这些服务，我们的目标是1）描述基于邮件注射器的全国扩展的政策障碍 服务和芬太尼剥离分布，2）进行国家纵向队列研究，以检查 吸收和长期参与基于邮件的损害减少服务，3）评估附加损害 邮件传递客户的减少和卫生服务偏好。对于AIM 1，我们将进行系统的法律 审查50个州和哥伦比亚特区的每个州的相关法律，以确定是否以及如何 州法律可能会影响通过邮件分发注射器和芬太尼测试条的合法性。我们将发展一个 政策的分类法可能会阻止法律扩展邮寄的注射器。理解 对潜在采用者中邮寄注射器相关的法律风险的看法，我们将调查和 面试来自代表不同法律的州的20个利益相关者（即卫生部门和SSP） 邮件交付的环境。对于AIM 2，我们将基于一项社交媒体招募的调查，以检查吸收 通过将调查的随访时间从6种扩展到6个 数月到12个月至12个月，并扩大了此调查的样本量。这将使我们能够评估 长期的摄取和减少损害危害参与的预测因素，以便完全 了解谁使用邮件传递服务以及如何随着时间的推移使用这些服务。对于目标3我们 将设计和实施离散选择实验（DCE）调查以确定基于邮件的服务客户 接受减少危害和卫生服务的偏好。这些结果将被传播到 政策利益相关者，潜在采用者和下一个分支机构，以告知基于邮件的扩展和扩大规模 损害减少服务，改善与当前的下一个用户的参与度，并扩展服务类型 通过这些程序提供。