Development of a novel community-based high-performance surveillance network for drug use

项目摘要 对药物使用的监督努力正在使我们失望。他们依赖于过时的风险预测工具，但艾滋病毒和过量的风险因素是特定的，并受到患者，提供者和系统层面因素以及社区流行病学现实之间相互作用的影响。他们依赖于直接估计方法来衡量流行率，但缺乏获得阿片类药物使用障碍（MOUD）和减少伤害服务，耻辱，毒品使用的刑事定罪和负担不起的住房等障碍阻止使用毒品的人（PWUD）被计算在内。此外，它们很少涉及社区参与，监测数据也没有有效地传播给社区，以实现最大效益。在持续的过量用药危机和最近在印第安纳州、马萨诸塞州、肯塔基州和西弗吉尼亚州的PWUD中爆发艾滋病毒的背景下，这一公共卫生基本工具的失败具有新的紧迫性。预防和治疗药物使用和艾滋病毒的有效方案和干预措施的数量继续增加，但如果没有准确估计有过量用药风险的人群的规模和获得艾滋病毒及其特定风险因素的知识，这些干预措施就无法充分发挥其潜力。我们无法接触到我们不知道存在和处于危险之中的人。因此，我们需要立即更新和提高我们的监测能力，以了解吸毒人口的规模和组成。我提出了一个创新的，跨学科的研究计划，整合流行病学，社区参与，生物统计学，计量经济学和信息传播，以创建一个新的社区为基础的，高性能的PWUD监测网络。我将通过以下方式做到这一点：（1）围绕PWUD的大数据创建社区参与研究（CEnR）过程;（2）为PWUD中的艾滋病毒感染，疾病进展和损失建立社区特定的风险预测算法;（3）使用增强的间接估计方法来确定PWUD人群的规模并评估干预措施的影响;（4）传播研究成果，将研究成果转化为行动。该计划的数据中心将是公共卫生数据仓库，这是一个来自超过15个马萨诸塞州政府机构的独立链接数据库，其中包括超过97%的马萨诸塞州人口。目前正在对这一数据库进行初步分析，并将向各社区提供实时数据。这个项目代表了一种完全不同于传统监视技术的方法，它结合了复杂的方法，社区始终处于过程的中心，从启动到最终输出。这个新颖的马萨诸塞州社区毒品使用监测（“Moma Dance”）网络将在马萨诸塞州开始，但将作为其他州和司法管辖区的典范，因为他们与自己的PWUD监测系统的失败作斗争。这些努力将把研究转化为社区一级的行动，并对吸毒和艾滋病毒流行病产生直接和持续的公共卫生影响。

PROJECT SUMMARY Surveillance efforts for substance use are failing us. They rely on outdated risk prediction tools yet risk factors for HIV and overdose are context-specific and are impacted by the interplay between patient-, provider-, and system-level factors as well as epidemiologic realities in a community. They rely on direct estimation methods for measuring prevalence yet barriers such as lack of access to medications for opioid use disorder (MOUD) and harm reduction services, stigma, criminalization of drug use, and unaffordable housing prevent people who use drugs (PWUD) from being counted. Additionally, they rarely involve community engagement and surveillance data are not disseminated effectively to communities to achieve maximum benefit. In the context of the ongoing overdose crisis and recent outbreaks of HIV among PWUD in Indiana, Massachusetts, Kentucky, and West Virginia, the failures of this basic tool of public health take on a new urgency. The number of efficacious programs and interventions to prevent and treat substance use and HIV continues to grow, but without accurate estimates of the size of the pool of people at risk of overdose and for acquiring HIV and knowledge of their specific risk factors, these interventions cannot reach their full potential. We cannot reach people who we do not know exist and are at risk. We, therefore, need to immediately modernize and upgrade our surveillance capacity to understand the size and composition of drug-using populations. I am proposing an innovative, interdisciplinary research program that integrates epidemiology, community engagement, biostatistics, econometrics, and information dissemination to create a novel community-based, high- performance surveillance network for PWUD. I will do this by (1) creating a community engaged research (CEnR) process around big data for PWUD; (2) building community-specific risk prediction algorithms for HIV acquisition, disease progression, and loss to follow up among PWUD; (3) using enhanced indirect estimation methods to determine the size of populations of PWUD and to evaluate the impact of interventions; and (4) disseminating findings and translating research into action. The data centerpiece of this program will be the Public Health Data Warehouse, an individually-linked database from more than 15 Massachusetts government agencies, which includes more than 97% of the Massachusetts population. Preliminary analyses with this database are underway and will be made accessible to communities in real-time. This project represents an approach that is entirely divergent from traditional surveillance techniques by using a combination of complex methodologies with the community always at the center of the process—from initiation to final output. This novel Massachusetts cOMmunity-bAsed Drug use surveillANCE (“Moma Dance”) Network will begin in Massachusetts, but will serve as a model for other states and jurisdictions as they contend with the failures of their own surveillance systems for PWUD. These efforts will translate research into action at the community level and have an immediate and sustained public health impact on the drug use and HIV epidemics.