Digital, Community-Led, Social Action Initiative to Reduce Opioid Vulnerability and HIV/HCV in Rural Areas of the Midwest and Appalachia

项目总结 该项目将开发、实施和评估一项变革性的虚拟倡议、高影响力的倡议，以保护在美国阿片类药物流行期间面临艾滋病毒/丙型肝炎疫情风险的农村吸毒人群。大多数艾滋病毒/丙型肝炎高风险县集中在阿巴拉契亚和中西部。尽管阿片类药物危机的根源很复杂，但健康的社会决定因素、对阿片类药物的误解以及孤立和绝望的文化是最关键的原因。然而，互联网的使用在这些地区的阿片类药物使用者中很常见(例如，Facebook、谷歌)，并可能支持可扩展的方案，以补充难以到达的地区对危机的医疗和公共卫生反应。该项目将涉及两个创新的平台模块：社会行动(虚拟会议和联网、与卫生官员的联系、社区协商和战略新闻发布)和沟通(揭露误解的信息；促进艾滋病毒/丙型肝炎病毒检测、注射器交换和艾滋病毒暴露前预防的信息；通过现场聊天提出的问题的现场答复)。数字平台将结合大数据方法来识别有效消息、误解和揭穿消息。该项目将以农村千禧一代(18-35岁)为目标，这一群体足够年轻，具有可塑性，以防止阿片成瘾和中年的负面健康后果。因此，该项目符合NIDA的议程，即针对阿片类药物流行制定快速、可扩展和得到社会支持的应对措施。为了评估这一举措，首席调查员(PI)及其同事将对使用阿片类药物的参与者(n=1,200)和非使用阿片类药物的社区成员(n=1,200)进行整群随机对照试验。评估将在一年内每四个月进行一次。试验结果将包括艾滋病毒/丙型肝炎病毒检测、参与注射器交换、使用避孕套、以性行为换取金钱或毒品、启动PrEP、药物辅助药物滥用治疗、以及避免与药物有关的不良事件的措施(例如，携带纳洛酮药盒以扭转过量服药)，以及隔离和污名措施。安纳伯格公共政策中心承诺与www.FactCheck.org同时托管和维护该平台，以确保可持续性。鉴于在任何领域都缺乏类似的社会行动平台，而且迫切需要为面临艾滋病毒/丙型肝炎爆发风险的农村、白人、贫困和反注射器交换县提供创新和具有成本效益的方法，该项目体现了先锋计划的愿景。PI在行为改变、艾滋病毒和数字传播方面有着新颖、复杂、理论上知情和成功的研究记录。对该项目的机构支持非常出色，其中包括www.thegrov.org，这是一个由PI共同指导的减少阿片类药物脆弱性的联盟。该项目汇集了11所顶尖大学和令人印象深刻的州卫生部门网络的优秀和坚定的研究人员。

PROJECT SUMMARY This project will develop, implement, and evaluate a transformative virtual initiative, high-impact initiative for protecting rural drug-using populations at risk from HIV/HCV outbreaks in the midst of the opioid epidemic in the United States. Most counties at high risk for HIV/HCV outbreaks are clustered in Appalachia and the Midwest. Although the origins of the opioid crisis are complex, social determinants of health, misconceptions about opioids, and a culture of isolation and despair are among the most critical causes. However, Internet use is common among opioid users in these areas (e.g., Facebook, Google) and may support scalable programs to supplement medical and public health responses to the crisis in difficult to reach regions. This project will involve two innovative platform modules: Social Action (virtual meeting and networking, contact with health officials, community consultation, and strategic news releases); and Communication (messages debunking misconceptions; messages promoting HIV/HCV testing, syringe exchange, and HIV pre-exposure prophylaxis (PrEP); on-the-spot responses to questions posed via live chat). The digital platform will incorporate Big Data methods to identify efficacious messages, misconceptions, and debunking messages. The project will target rural millennials (ages 18-35), a population that is sufficiently young to be malleable, to prevent opioid addiction and negative health outcomes in middle age. Thus, this project aligns with the NIDA agenda of generating rapid, scalable, and socially supported responses to the opioid epidemic. To evaluate the initiative, the Principal Investigator (PI) and colleagues will conduct a cluster randomized controlled trial with opioid using participants (n = 1,200) and non-opioid-using community members (n = 1,200). Assessments will occur every four months over a year. Trial outcomes will include HIV/HCV testing, syringe exchange participation, condom use, exchanging sex for money or drugs, initiation of PrEP, medication-assisted substance abuse treatment, and measures to avoid drug-related adverse events (e.g., carrying Naloxone kits for reversing overdoses), in addition to isolation and stigma measures. The Annenberg Public Policy Center has committed to hosting and maintaining the platform in parallel with www.FactCheck.org, ensuring sustainability. Given the lack of a similar social action platform in any domain and the urgent need for innovative and cost-effective approaches for the largely rural, white, poor, and anti-syringe-exchange counties at risk for HIV/HCV outbreaks, this project exemplifies the vision of the Avant-Garde Program. The PI has a distinguished record of novel, complex, theoretically-informed, and successful research on behavior change, HIV, and digital communication. The institutional support for this project is outstanding and includes www.thegrov.org, a coalition to reduce opioid vulnerability co-directed by the PI. The project brings together stellar and committed investigators at eleven elite universities and an impressive network of state health departments.