Identifying Ecologically Valid Intervention Opportunities to Reduce Opioid Injection Drug Use in Southwestern Pennsylvania

确定生态上有效的干预机会，以减少宾夕法尼亚州西南部阿片类注射药物的使用

• 批准号: 9266851
• 负责人: Jessica Griffin Burke
• 金额: $ 15.43万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9266851
• 关键词: Address; Advisory Committees; Alcohol or Other Drugs use; Appalachian Region; Area; Attention; Code; Collaborations; Communities; Comorbidity; County; Data; Dependence; Development; Disease Outbreaks; Distress; Drug Addiction; Drug abuse; Drug usage; Economic Conditions; Epidemic; Foundations; Funding; Goals; Grant; Growth; HIV; HIV Infections; HIV/HCV; Health; Health Personnel; Health Professional; Hepatitis C; Heroin; Heroin Dependence; Hospitalization; Hospitals; Hot Spot; Injection of therapeutic agent; Inpatients; Intervention; Interview; Investigation; Lawyers; Link; Measures; Mental Health; Methods; Modeling; Opioid; Overdose; Patients; Pattern; Pennsylvania; Pilot Projects; Planet Mars; Poverty; Prevention; Preventive Intervention; Probability; Public Health; Recording of previous events; Research; Research Methodology; Research Project Grants; Resources; Rural; Sampling; Time; Work; experience; informant; injection drug use; insight; meetings; novel; opioid abuse; opioid use; opioid use disorder; programs; response; social; successful intervention

ABSTRACT Opioid abuse rates are exploding in rural and economically distressed communities in the Appalachian region and associated health consequences, including Hepatitis C (HCV) and HIV, are also on the rise. The harmful impact of opioids have received national attention, yet the drivers of the spread of opioid use disorders (OUD) and overdose across communities are not yet understood. In addition, the intertwined relationship between injection opioid drug use and co-morbidities including Hepatitis C and HIV infection necessitate further investigation to inform integrated prevention and intervention efforts. Few studies have used an in-depth, ecologically valid approach to collect information from local community stakeholders with contextually specific experience addressing the epidemic. The overall goal of this one-year planning research grant (in response to RFA-DA-16-015) is to examine contextually- and temporally-specific patterns of the opioid epidemic in the Northern Appalachian Region of Southwestern Pennsylvania using complementary quantitative and qualitative approaches. We propose to use a mixed methods approach incorporating spatial analyses of OUD and overdose hospitalizations and qualitative data from local stakeholders to better understand the spread of opioid injection drug use in the ten counties that make up the Northern Appalachian Region of Southwestern Pennsylvania. The Specific Aims of this proposal are: (1) To characterize the growth and spread of opioid drug abuse, dependence, and overdose and associated co-morbidities (HCV and HIV) over time and space and (2) To identify resources and intervention opportunities associated with opioid drug abuse, dependence, and overdose and associated co-morbidities within one “hot spot” community. We will combine 16 years of well- resolved spatial data with qualitative data to be collected using a community engaged approach and in-depth interviews in a purposefully sampled target case community. We will start by examining hospital patient spatial data at the ZIP code level to measure the geographic growth and spread of OUD and two comorbid conditions (HCV & HIV) as measured by 64 quarters of inpatient hospitalization data (from 2000 through 2015). We will identify specific attributes of areas (e.g., economic conditions) that facilitate spread over time across ZIP codes, and distinguish the temporal scale of these impacts. Spatial random effects models and posteriors from these models will be used to identify one “case” community (defined by 2015 ZIP code boundaries) with the greatest predicted probability of comorbid epidemic outbreak. In this case community we will identify and engage key stakeholders, including clinicians & treatment providers (focused on opioids, HCV, and HIV), and others (e.g. former opioid injection users) identified through snowball sampling. We will use qualitative interviews with 20 informants to identify drivers of the intersecting epidemics and existing resources and novel intervention opportunities. This work will lay the foundation for larger action-oriented research and planning efforts addressing opioid injection drug use, HCV and HIV in the Appalachian region.

抽象的 阿巴拉契亚地区的农村和经济困境的社区正在爆炸阿片类药物滥用率 以及包括丙型肝炎（HCV）和HIV在内的相关健康后果也正在上升。有害 阿片类药物的影响受到了全国关注，但是阿片类药物使用障碍的驱动因素（OUD） 尚未了解整个社区的过量。另外，交织在一起的关系 注射阿片类药物的使用和合并症，包括丙型肝炎和HIV感染，还需要进一步 调查以告知综合预防和干预工作。很少有研究深入 生态有效的方法是从当地社区利益相关者那里收集具有特定特定特定特定的信息的信息 解决流行病的经验。这项为期一年的计划研究赠款的总体目标（回应 RFA-DA-16-015）是检查阿片类药物流行的上下文和暂时特定的模式 宾夕法尼亚州北部阿巴拉契亚地区使用完整的定量和定性 方法。我们建议使用一种混合方法，以增加OUD的空间分析和 过量的住院和当地利益相关者的定性数据，以更好地了解OOID的传播 构成西南北阿巴拉契亚地区的十个县的注射毒品使用 宾夕法尼亚州。该提案的具体目的是：（1）表征阿片类药物的生长和传播 滥用，依赖性和过量和相关的合并症（HCV和HIV）随时间和空间和（2） 确定与阿片类药物滥用，依赖性以及 在一个“热点”社区中过量服用和相关的合并症。我们将结合16年的良好 已解决的空间数据以及使用社区参与方法和深入的定性数据进行的定性数据 有目的地采样的目标案例社区进行访谈。我们将首先检查医院的患者空间 邮政编码级别的数据，以衡量OUD和两个合并条件的地理增长和传播 （HCV和艾滋病毒）通过64个季度住院住院数据（2000年至2015年）测量。我们将 确定促进随时间扩散在拉链的地区（例如经济状况）的特定属性（例如，经济状况） 代码，并区分这些影响的临时规模。空间随机效应模型和后代 这些模型将用于识别一个“案例”社区（由2015年邮政编码边界定义） 合并症流行病的最大预测概率。在这种情况下，我们将确定并 参与关键利益相关者，包括临床医生和治疗提供者（专注于阿片类药物，HCV和HIV），以及 其他人（例如前阿片类注射使用者）通过雪球采样确定。我们将使用定性 与20名线人的访谈，以确定相交情节和现有资源的驱动因素以及新颖 干预机会。这项工作将为更大的面向行动的研究和计划奠定基础 阿巴拉契亚地区的阿片类药物注射药物，HCV和HIV的努力。