Syringe Services Program Implementation in Rural Counties Vulnerable to HIV Outbreak

项目摘要/摘要 最近印第安纳州斯科特县与注射处方阿片类药物有关的艾滋病毒爆发突显了 农村社区对艾滋病毒和病毒性肝炎的传入和在人群中迅速传播的脆弱性 注射毒品者(PWID)。在这种流行病之后，美国各地的司法管辖区重新努力 解决阿片注射和艾滋病毒感染的综合症，包括实施注射器服务方案(SSP)。 在PWID中，SSP与艾滋病毒和病毒性肝炎发病率的下降有关。建模研究已经 表明实施SSP具有成本效益，通过避免艾滋病毒节省了数百万的医疗成本 感染。尽管SSP对公众健康的益处是有据可查的，但大多数检查其效用的研究都是 在大城市地区进行；关于农村实施SSP的文献匮乏。这是一个关键的差距 这些文献表明，疾病控制和预防中心确定了220个以农村为主的县 易受阿片类药物注射相关艾滋病毒爆发影响的26个州。这项研究的目的就是解决这一问题 通过以下具体目标，我们对农村SSP的理解存在差距：(1)确定什么是个人层面(例如， 性别、首选注射毒品)和社区特征(例如失业率和逮捕率)是相关的 在SSP使用者(n=330)和非使用者中使用艾滋病毒预防服务(例如，SSP参与、HIV检测) 在阿巴拉契亚两个容易爆发艾滋病毒的农村县(n=330)；(2)探索障碍和促进者(例如， 社区反应、政策环境)在阿巴拉契亚两个易感染艾滋病毒的农村县实施SSP 在40个利益相关者中有无SSP爆发；(3)在两个农村地区进行SSP实施的成本分析 阿巴拉契亚地区易受艾滋病毒爆发影响的县。目标1将使我们更好地了解个人和社区 农村残疾人艾滋病预防服务利用特征。这些数据将向 制定未来的干预措施，旨在减少农村残疾人中的艾滋病毒危险行为。通过半结构化 关键线人访谈(目标2)，我们将能够比较农村实施SSP的障碍和促进者 有无SSP的县。目标3的结果将对农村实施SSP的成本以及如何 服务的提供可能会受到资金水平变化的影响。这项研究项目将嵌入一个 全面的培训计划，包括课程、研讨会、指导学习和由既定团队进行的指导 专家们的意见。该培训计划旨在增强我的长处并培养新的研究技能，同时做出贡献 对我们对农村SSP的科学理解。培训提案详细说明了正式和非正式的五年计划 讲授：多层次建模、实施科学和成本分析。我的短期职业目标包括： 完成所有培训领域的课程作业，通过出版物和演示文稿传播研究结果， 从事职业发展活动，并在获奖的最后几年申请独立的R01资金。我的 长期的职业目标是成为农村地区药物依赖和艾滋病毒预防的独立调查员。

PROJECT SUMMARY/ABSTRACT The recent HIV outbreak linked to the injection of prescription opioids in Scott County, Indiana highlighted the vulnerability of rural communities to the introduction and rapid transmission of HIV and viral Hepatitis among persons who inject drugs (PWID). In the wake of this epidemic, jurisdictions across the United States have renewed efforts to address the syndemic of opioid injection and HIV infection, including by implementing syringe services programs (SSPs). SSPs are associated with decreases in incidence rates of HIV and viral Hepatitis among PWID. Modeling studies have shown that SSP implementation is cost-effective, resulting in millions in healthcare cost savings from averted HIV infections. Although the public health benefits of SSPs are well documented, most studies that examined their utility were conducted in major urban areas; a scarcity of literature exists regarding rural SSP implementation. This is a critical gap in the literature given that the Centers for Disease Control and Prevention identified 220 predominantly rural counties across 26 states that are vulnerable to an opioid injection-related HIV outbreak. The purpose of this research is to address this gap in our understanding of rural SSPs through the following specific aims: (1) to determine what individual-level (e.g., gender, injection drug of choice) and community-level characteristics (e.g., unemployment and arrest rates) are associated with HIV prevention services utilization (e.g., SSP engagement, HIV testing) among SSP users (n=330) and nonusers (n=330) in two rural Appalachian counties vulnerable to HIV outbreak; (2) to explore barriers and facilitators (e.g., community response, policy environment) of SSP implementation in two rural Appalachian counties vulnerable to HIV outbreak with and without SSPs among 40 stakeholders; (3) to conduct cost analyses of SSP implementation in two rural Appalachian counties vulnerable to HIV outbreak. Aim 1 will allow us to better understand the individual and community characteristics associated with HIV prevention services utilization among rural PWID. These data will inform the development of future interventions that aim to reduce HIV risk behaviors among rural PWID. Through semi-structured key informant interviews (Aim 2), we will be able to compare the barriers and facilitators of SSP implementation in rural counties with and without SSPs. The results of Aim 3 will shed insights on rural SSP implementation costs and how service delivery may be impacted by changes in funding levels. This research project will be embedded in a comprehensive training program consisting of coursework, seminars, guided study, and mentorship by an established team of experts. The training program is designed to further my strengths and to develop new research skills while contributing to our scientific understanding of rural SSPs. The training proposal details a five-year plan of formal and informal instruction in: multilevel modeling, implementation science, and cost analyses. My short-term career goals include: completing coursework in all training areas, disseminating study findings through publications and presentations, engaging in career development activities, and applying for independent R01 funding in the latter years of the award. My long-term career goal is to become an independent investigator in drug dependence and HIV prevention in rural areas.