Intersectional stigma among rural buprenorphine providers as a barrier to diffusion of harm reduction strategies and interventions to enhance engagement in treatment for HIV and opioid use disorders

农村丁丙诺啡提供者之间的交叉耻辱是传播减少伤害策略和干预措施的障碍，以加强对艾滋病毒和阿片类药物使用障碍的治疗参与

• 批准号: 10657755
• 负责人: Phillip L Marotta
• 金额: $ 20.15万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10657755
• 关键词: AIDS prevention; Address; Adoption; Advocate; African American population; Agreement; Applications Grants; Area; Attitude; Award; Behavior; Buprenorphine; Caring; Clinic; Communities; Continuity of Patient Care; Data; Data Analyses; Data Collection; Development; Diffusion; Disease remission; Drug Prescriptions; Epidemic; Evidence based intervention; Evidence based practice; Federally Qualified Health Center; Funding; Geographic Locations; Goals; Government Agencies; HIV; HIV Infections; Harm Reduction; Health Service Area; Health Services Accessibility; Human Resources; Individual; Intervention; Interview; Midwestern United States; Missouri; Naloxone; Naltrexone; National Institute of Drug Abuse; Needle-Exchange Programs; Neighborhood Health Center; Overdose; Patient Recruitments; Patients; Persons; Pharmaceutical Preparations; Play; Policies; Primary Care; Process; Provider; Public Health; Research; Research Activity; Research Priority; Role; Rural; Rural Community; Rural Population; Services; Sex Orientation; Sexuality; Shapes; Stigmatization; Surveys; Testing; United States; United States Health Resources and Services Administration; Universities; Viral; Washington; Work; Writing; community based treatment; design; disorder prevention; evidence base; health organization; improved; insight; novel strategies; opioid use disorder; pre-exposure prophylaxis; prevention service; primary care provider; primary care setting; remediation; research study; retention rate; rural area; scale up; service delivery; social stigma; substance use treatment; willingness

Missouri (MO) is an Ending the HIV Epidemic (EHE) priority state because of the disproportionate occurrence of HIV as well as poor rates of engagement along the HIV care continuum in rural areas. Intersecting stigmas remain a significant barrier to ending the HIV epidemic in MO and other rural areas by impeding technical capacity building and integration of comprehensive evidence-based harm reduction strategies and medication treatment for opioid use disorders (MOUD) into rural primary care. Intersecting enacted drug, HIV and sexual orientation stigmas are drivers of lower rates of engagement along the HIV care continuum among African American people with HIV and OUD accessing care in Missouri. Intersecting enacted stigmas present barriers to scaling up comprehensive harm reduction by impeding providers' willingness to see value in and compatibility of integrating harm reduction strategies into their existing practices. Research is lacking that examines the role of intersecting stigmas in shaping providers' decisions to write prescriptions for buprenorphine, naltrexone and PrEP in Missouri. To address these gaps in the research, we will use this R21 Exploratory/Development award to 1) identify mechanisms through which intersectional drug, HIV, and sexuality-based stigmas influence buprenorphine providers' diffusion, acceptance and adoption of OUD and HIV prevention harm reduction practices (Aim 1a); buprenorphine, naltrexone and PrEP prescribing (Aim 1b) using fixed-choice surveys administered to 420 rural providers and; Aim 2) conduct in-depth interviews with key stakeholders to elucidate multi-level intersectional stigmas at the individual-, provider-, clinic-, community and policy-levels, and possible strategies to reduce stigma with (a) providers (n=30), (b) people living with HIV and OUD (n=24), (c) community advocates (n=6) and (d) regional leaders in OUD and HIV infection, (n=6). The main hypothesis of this study is that intersectional stigmas inhibit technical capacity building that is necessary for rural MO to offer patients high- quality, comprehensive harm reduction services and integration of EBIs and keep them engaged in care. The proposed application embeds the use of key stakeholders into part of the research process first through extensive buy-in from 9 state associations and government agencies then through qualitative interviews to generate avenues for possible intervention and sustainability. Funding for this grant application will break new ground in rural MO and provide critical assistance to advancing the scaling up of harm reduction and treatment approaches in a geographical area where services are lacking. The proposed research will lead to the development of a stigma reduction intervention to increase adoption and diffusion of harm reduction strategies and buprenorphine prescribing. Devising novel strategies is key to optimizing and treatment, community-based treatments for opioid use disorders HIV infection among rural providers in MO and is critical to addressing lagging rates of engagement in remission and suppression.

密苏里州 (MO) 是终结艾滋病毒流行 (EHE) 的优先州，因为 艾滋病毒以及农村地区艾滋病毒护理连续性的参与率很低。交叉柱头 通过阻碍技术，仍然是结束密苏里州和其他农村地区艾滋病毒流行的重大障碍 能力建设以及全面的基于证据的减少伤害策略和药物的整合 将阿片类药物使用障碍 (MOUD) 的治疗纳入农村初级保健。毒品、艾滋病毒和性的交叉 定向耻辱是非洲艾滋病毒护理连续体参与率较低的驱动因素 美国艾滋病毒携带者和 OUD 患者在密苏里州获得护理。交叉的污名构成了障碍 通过阻碍提供者看到价值和兼容性的意愿来扩大全面减少危害的范围 将减少危害战略纳入其现有实践。缺乏研究来检验其作用 交叉耻辱影响提供者决定开出丁丙诺啡、纳曲酮和 密苏里州的 PrEP。为了解决研究中的这些差距，我们将使用 R21 探索/开发奖 1）确定交叉毒品、艾滋病毒和基于性的耻辱的影响机制 丁丙诺啡提供者对 OUD 的传播、接受和采用以及艾滋病毒预防和减少伤害 实践（目标 1a）；使用固定选择调查进行丁丙诺啡、纳曲酮和 PrEP 处方（目标 1b） 管理 420 个农村服务提供者；目标 2）与主要利益相关者进行深入访谈以阐明 个人、提供者、诊所、社区和政策层面的多层次交叉耻辱，以及可能的 减少耻辱的战略：(a) 提供者 (n=30)、(b) 艾滋病毒感染者和 OUD 感染者 (n=24)、(c) 社区 OUD 和 HIV 感染领域的倡导者 (n=6) 和 (d) 地区领导者 (n=6)。本研究的主要假设是 交叉耻辱抑制了农村 MO 为患者提供高水平服务所必需的技术能力建设 优质、全面的减害服务和 EBI 整合，并让他们参与护理。这 拟议的应用程序首先通过广泛的研究将关键利益相关者的使用嵌入到研究过程的一部分 获得 9 个州协会和政府机构的支持，然后通过定性访谈来产生 可能的干预和可持续性的途径。本次赠款申请的资助将在以下方面开辟新天地： 农村 MO 并为推进扩大减少伤害和治疗方法提供重要援助 在缺乏服务的地理区域。拟议的研究将导致开发 减少耻辱干预措施，以增加减少伤害策略和丁丙诺啡的采用和传播 开处方。制定新颖的策略是优化的关键 和 治疗， 阿片类药物使用障碍的社区治疗 密苏里州农村服务提供者中的艾滋病毒感染率对于解决农村服务提供者参与率滞后问题至关重要 缓解和抑制。