Implementing a Community-Based Response to the Opioid Epidemic in Rural Ohio

对俄亥俄州农村地区的阿片类药物流行病实施基于社区的应对措施

基本信息

批准号：
9411966
负责人：
VIVIAN F. GO
金额：
$ 59.18万
依托单位：
OHIO STATE UNIVERSITY
依托单位国家：
美国
项目类别：
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/9411966
关键词：
Abnormal coordination Acute Hepatitis C Address Adoption Advocacy Affect Alcohol or Other Drugs use Appalachian Region Behavior Birth Caring Cessation of life Characteristics Collaborations Communities Comorbidity Consensus Cost Savings Country County Data Data Sources Death Rate Decision Making Drug Addiction Epidemic Epidemiology Evidence based intervention Funding Geography HIV HIV/HCV Health Health Personnel Health Services Health Services Accessibility Healthcare Hepatitis B Hepatitis C Heroin Human Resources Human immunodeficiency virus test Immunization Injectable Injecting drug user Injection of therapeutic agent Intervention Interview Law Enforcement Laws Legal Maps Methods Modeling Monitor Morbidity - disease rate Naloxone Needs Assessment Neonatal Abstinence Syndrome Ohio Opiate Addiction Opioid Outcome Overdose Patterns of Care Penetration Persons Pharmaceutical Preparations Phase Pike fish Policies Politics Powder dose form Preparation Prevalence Process Provider Public Sector Recruitment Activity Regulation Resources Respondent Risk Behaviors Rural Sampling Services Sexually Transmitted Diseases Social Characteristics Social Network Surveys Syringes Tars Techniques Telemedicine Testing Time Training Virus Virus Diseases Work base combat cost cost efficient data format design experience improved infectious disease treatment injection drug use medication-assisted treatment opioid abuse opioid use overdose death pill prevent programs public health relevance response rural America rural Americans rural area rural counties scale up screening service intervention surveillance data tool trafficking

项目摘要

PROJECT SUMMARY/ABSTRACT Ohio is experiencing one of the worst opioid injection epidemics in the country. The epidemic has severely affected rural Appalachian counties in southern Ohio, leading to a surge in overdose fatalities. Ohio’s heroin- related overdose rate is five times the national rate. In addition to overdose deaths, HCV has increased 400% between 2009-2013 and neonatal abstinence syndrome (NAS) has increased 9-fold between 2004-2014. Many evidence-based interventions (EBI), such as syringe service programs, medication-assisted treatment for substance use, naloxone provision for overdose treatment, and testing for HCV, HIV and sexually transmitted diseases (STD) are known to be effective in combating injection drug addiction and its consequences. Unfortunately, little is known about how to apply lessons learned in urban injection drug epidemics to sparsely- populated rural areas. In rural Ohio, as in much of the U.S., the delivery of EBI is limited or fragmented. A lack of coordination between key agencies to address overlap and gaps in services, especially in the context of severely constrained resources, has dire consequences for those struggling with opioid injection drug use. The proposed study will develop and implement a service delivery plan for EBI that can be scaled up in rural Ohio as well as other rural areas in the US experiencing opioid epidemics. In the UG3 phase, we will use a mixed methods approach to assess the socio-cultural and political context of the epidemic across multiple levels, including agencies, health care and service providers, and people who inject drugs (PWID) within three counties in rural Appalachia. We will use respondent-driven sampling (RDS) to assess injection behaviors and HCV, HIV, and STD prevalence. Building on this multi-level formative data, we will identify service gaps and work closely with key community stakeholders to build consensus around and prioritize the most relevant, feasible and acceptable implementation strategies to deliver EBI that may include coalition building, data synthesis across counties, crowdfunding models, and telemedicine. In the UH3 phase, we will implement, monitor and evaluate our service delivery plan for opioid injectors, using a regression point displacement design and repeat RDS surveys. Outcomes will include overdose deaths, NAS cases, HCV and HIV tests performed, and referral for HCV and HIV care. Implementation outcomes will include acceptability, adoption, feasibility, fidelity, penetration, sustainability, and cost. Scalability will be assessed by applying lessons learned in the UG3 phase in three additional counties during the UH3. Upon completion of the study, we will have enhanced EBI service delivery in multiple counties in Ohio and developed an exportable model of service needs assessment, community-engaged decision-making, and implementation. This model will be suitable for use throughout rural American in settings where opioid addiction has been identified and existing service delivery is limited or fragmented.

项目概要/摘要俄亥俄州正在经历该国最严重的阿片类药物注射流行病之一。影响了俄亥俄州南部的阿巴拉契亚乡村县，导致俄亥俄州吸食海洛因过量死亡人数激增。相关过量用药率是全国的五倍除了过量用药死亡外，丙肝病毒也增加了400%。 2009 年至 2013 年期间，新生儿戒断综合症 (NAS) 增加了 9 倍，2004 年至 2014 年期间增加了 9 倍。基于证据的干预措施 (EBI)，例如注射器服务计划、药物辅助治疗物质使用、纳洛酮过量治疗以及 HCV、HIV 和性传播疾病检测众所周知，疾病（STD）可以有效对抗注射吸毒成瘾及其后果。不幸的是，人们对如何将城市注射毒品流行中的经验教训应用到稀疏的地方知之甚少。与美国大部分地区一样，在俄亥俄州的农村地区，EBI 的实施有限或分散。关键机构之间的协调，以解决服务重叠和差距问题，特别是在资源严重受限，给那些因阿片类注射毒品而苦苦挣扎的人带来了可怕的后果。拟议的研究将制定并实施一项 EBI 服务提供计划，该计划可以在俄亥俄州以及美国其他正在经历阿片类药物流行的农村地区，我们将在 UG3 阶段使用。采用混合方法评估流行病的社会文化和政治背景级别，包括机构、医疗保健和服务提供者以及注射吸毒者 (PWID) 三年内我们将使用参与者驱动的抽样 (RDS) 来评估注射行为和基于这些多层次的形成性数据，我们将确定丙型肝炎病毒、艾滋病毒和性传播疾病的患病率。与主要社区利益相关者密切合作，围绕最相关的问题建立共识并优先考虑可行且实施可接受的策略来提供 EBI，其中可能包括联盟建设、数据跨县综合、众筹模式和远程医疗在 UH3 阶段，我们将实施，使用回归点位移来监控和评估我们的阿片类药物注射器服务交付计划设计和重复 RDS 调查结果将包括过量死亡、NAS 病例、HCV 和 HIV 检测。执行，并转介 HCV 和 HIV 护理实施结果将包括可接受性、采用、将通过吸取经验教训来评估可行性、保真度、渗透性、可持续性和可扩展性。 UH3 期间另外三个县也处于 UG3 阶段。研究完成后，我们将加强俄亥俄州多个县的 EBI 服务交付开发了服务需求评估、社区参与决策的可输出模型，以及该模型将适用于整个美国农村地区阿片类药物的使用。已发现成瘾现象，现有的服务提供有限或支离破碎。