Kentucky Communities & Researchers Engaging to Halt the Opioid Epidemic-CARE2HOPE

肯塔基州社区

• 批准号: 9709969
• 负责人: Hannah LF Cooper
• 金额: $ 16.02万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-15 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9709969
• 关键词: Address; Adopted; Adoption; Appalachian Region; Back; Budgets; Case Study; Centers for Disease Control and Prevention (U.S.); Cities; Client; Communities; County; Disease Outbreaks; Effectiveness; Epidemic; Epidemiology; Evidence based intervention; Face; Future; HIV; HIV/HCV; Harm Reduction; Health Promotion; Health Services; Health system; Hepatitis C virus; Heroin; Incidence; Indiana; Injecting drug user; Kentucky; Knowledge; Legal; Medical; Movement; Needle-Exchange Programs; Needles; New York; Newly Diagnosed; North Carolina; Overdose; Perception; Pharmaceutical Preparations; Population; Process; Program Sustainability; Public Health; Recording of previous events; Research; Research Design; Research Personnel; Risk; Risk Behaviors; Rural; Science; Services; Sterility; Syringes; System; Testing; Transportation; Travel; Variant; Water; West Virginia; base; cost; design; health service use; heroin use; implementation research; implementation science; innovation; meetings; mortality; next generation; novel; novel strategies; opioid epidemic; opioid misuse; opioid mortality; opioid use; overdose risk; prescription opioid misuse; programs; rural area; rural counties; trend; young adult

Epicenters of opioid misuse and related harms (e.g., HCV, overdose, HIV) are expanding from cities to rural areas in the US. These seismic epidemiologic shifts are crises that rural public health systems have yet to meet, and a wide “implementation chasm” exists for drug-related health services in rural areas. Kentucky – a predominately rural state at the forefront of these drug-related epidemics – is starting to close this chasm by mounting an unprecedented expansion of syringe service programs (SSPs). Between 2015 and 2018, the number of legal SSPs operating in Kentucky surged from 0 to 40. This Kentucky expansion is part of a broader trend in the Appalachian region and other rural areas. This expansion represents a “scale out” that takes SSPs to implementation contexts that differ qualitatively from their urban origins. Rural areas may present a constellation of barriers and facilitators to SSP adoption, fidelity, and sustainment that differ from those in cities. Cost, for example, may be a more significant barrier to adoption, fidelity, and sustainment in rural areas, where budgets are far more constrained. SSP staff may generate novel ways to implement core components that suit rural contexts, and SSP impact on risk behaviors and service use among clients may also be different in rural areas (e.g., transportation barriers and the paucity of local services may limit successful linkage to other services). Notably, little research has explored these possibilities: a recent Medline search using variants of the terms “SSP,” “rural,” and “implementation science” identified no articles. The proposed study is a first step toward establishing the next generation of implementation science to enhance the effectiveness of this new wave of rural SSPs. Guided by the Consolidated Framework for Implementation Research, we will use a qualitative, multiple case study design to study SSPs that recently opened in 7 rural Kentucky counties to (1) Identify perceived barriers and facilitators in the rural implementation context to adopting and sustaining SSPs, and explore strategies to overcome barriers to adoption and sustainment. (2) Analyze the extent to which SSPs are faithful to established core components; identify emerging novel approaches to implementing core components that these SSPs may have innovated; and examine the processes through which select, salient features of the implementation context may have influenced this fidelity and innovation. (3) Explore PWID perceptions of whether and how SSP core components influence HIV, HCV, and overdose risk behaviors and drug-related health service use among SSP clients and other local PWID. This is a supplement to “CARE2HOPE” (DA044798). Led by Drs. Young and Cooper, CARE2HOPE is designed to build evidence- based interventions (EBIs) for epidemics of opioid misuse and related harms in 12 rural Kentucky counties at an epicenter of these intertwined national crises. Several CARE2HOPE counties are considering enhancing SSPs as part of their EBI. This supplement will help identify barriers to SSP fidelity or sustainment that they could address. It will also generate hypotheses for a new line of high-impact rural SSP implementation science.

阿片类药物滥用和相关危害（例如丙型肝炎病毒、用药过量、艾滋病毒）的中心正在从城市扩大到农村 这些巨大的流行病学变化是农村公共卫生系统尚未应对的危机。 肯塔基州农村地区与毒品相关的卫生服务存在巨大的“实施鸿沟”。 以农村为主的国家处于这些与毒品有关的流行病的最前线 - 正在开始弥合这一鸿沟 2015 年至 2018 年间，注射器服务计划 (SSP) 规模空前扩大。 在肯塔基州运营的合法 SSP 数量从 0 家激增至 40 家。肯塔基州的这一扩张是更广泛的计划的一部分 阿巴拉契亚地区和其他农村地区的趋势表明，这种扩张代表了 SSP 的“向外扩展”。 与城市起源有本质不同的实施环境可能会带来不同的结果。 SSP 采用、忠诚度和维持的障碍和促进因素与其他方面不同 例如，成本可能是农村地区采用、忠诚度和维持的更大障碍， 在预算更加有限的情况下，SSP 工作人员可能会想出新的方法来实施核心组件。 适合农村环境的 SSP 对客户风险行为和服务使用的影响也可能不同 在农村地区（例如，交通障碍和当地服务的缺乏可能会限制与农村地区的成功联系） 值得注意的是，很少有研究探索这些可能性：最近的 Medline 搜索使用了变体。 术语“SSP”、“农村”和“实施科学”未识别出任何文章。拟议的研究是第一个。 朝着建立下一代实施科学迈出的一步，以提高这一成果的有效性 在实施研究综合框架的指导下，我们将采用 定性、多案例研究设计，研究最近在肯塔基州 7 个农村县开设的 SSP，以 (1) 确定农村实施背景下采用和维持 SSP 的明显障碍和促进因素， (2) 分析其程度 SSP 忠实于已建立的核心组件；确定新兴的新方法来实施核心 这些 SSP 可能已经创新的组件；并检查选择突出的流程 (3) 探索注射吸毒者 对 SSP 核心成分是否以及如何影响 HIV、HCV 和用药过量风险行为的看法，以及 SSP 客户和其他当地注射吸毒者之间使用毒品相关的医疗服务 这是对 SSP 客户和其他当地吸毒者的补充。 “CARE2HOPE”（DA044798）由 Young 和 Cooper 博士领导，旨在建立证据- 针对肯塔基州 12 个农村县阿片类药物滥用流行及相关危害的基于干预措施 (EBI) 多个 CARE2HOPE 县正在考虑加强这些相互交织的国家危机的中心。 SSP 作为其 EBI 的一部分，该补充将有助于识别 SSP 忠诚度或维持的障碍。 它还将为高影响力的农村 SSP 实施科学的新路线提出假设。

项目成果

The relationship between felt stigma and non-fatal overdose among rural people who use drugs.

农村吸毒者的耻辱感与非致命性吸毒过量之间的关系。

• 发表时间: 2024-04-06
• 影响因子: 4.4
• 作者: Sibley, Adams L;Klein, Emma;Cooper, Hannah L F;Livingston 3rd, Melvin D;Baker, Robin;Walters, Suzan M;Gicquelais, Rachel E;Ruderman, Stephanie A;Friedmann, Peter D;Jenkins, Wiley D;Go, Vivian F;Miller, William C;Westergaard, Ryan P;Crane, Hei
• 通讯作者: Crane, Hei