Novel methods for research on young rural opioid users at risk of HIV, HCV & OD

翻译后摘要：非医疗处方阿片类药物（NMPO）的使用，海洛因的使用和药物相关的危害（即， 艾滋病毒、丙型肝炎病毒和药物过量[ODs]）正在从城市转移到农村地区;农村年轻人（YA）正在承受 这些流行病学转变的冲击。最近在印第安纳州农村爆发的艾滋病毒疫情证明了这些危机， 转型可以创造。然而，科学未能跟上这些地震的变化。15年后 NMPO使用开始在农村地区激增，我们对NMPO使用的模式或决定因素知之甚少，海洛因 使用，艾滋病毒，丙型肝炎病毒和吸毒过量的农村青年。对农村阿片类药物使用者（不分年龄）的研究也得到了 有限：除了极少数例外，这项研究仅关注个人层面的预测因素。大量的 然而，以城市风险环境模型为指导的研究表明，对吸毒的脆弱性， 艾滋病毒和其他危害是由多个层面的因素造成的，包括社区。几乎所有 研究毒品使用及其危害的方法和措施被创造出来供城市使用， 关于农村YA阿片类药物使用者及其风险环境的新一代研究提出了主要的 方法和测量的挑战。目标抽样、响应者驱动抽样（RDS）和其他 招募城市吸毒者（PWUD）的方法在人口密度高的情况下最有效 高，环境服务丰富，公共交通将参与者连接到研究地点;这些相同 （城市）功能方便了研究中常见的亲自调查管理和生物样本收集 城市PWUD然而，这些招募和数据收集方法在农村地区很常见， 人口稀少，为残疾人和女童提供的服务很少，缺乏公共交通。在农村地区实施REM 也提出了测量挑战，部分是因为数据可用的地理单元（例如， 人口普查区块组）在农村地区太大，无法准确描述当地环境。 由具有丰富互补专业知识的双PI团队领导的拟议混合方法R21研究将奠定 新一代理论上知情的，严格的，可重复的，高影响力的多层次的基础 研究风险环境如何影响非营利组织和海洛因使用和艾滋病毒，丙型肝炎病毒，和OD之间的雅， 美国多个乡村。它将通过利用目标地区高水平的互联网使用来奠定这些基础 人口，并将实现以下目标：目标1。开发和测试使用（a）WebRDS的可行性， 虚拟形式的RDS，和（B）虚拟资格筛选器，以在一个实施例中创建YA阿片样物质使用者的样本（N=200）。 NMPO使用、海洛因使用和相关危害的农村中心（肯塔基州罗文县）。目标2.创建和 验证农村风险环境特征的新的基于调查的虚拟地理空间措施。目标3：到 （a）对农村风险环境、毒品使用模式、艾滋病毒和丙肝病毒风险进行互联网调查; 样品中OD风险和发生率;和（B）子样品中基于家庭的HIV测试系统。目标3.1。 分析Aim 3数据，为新一代高影响力多层次研究的功效计算提供信息。

Abstract: Epicenters of non-medical prescription opioid (NMPO) use, heroin use, and drug-related harms (i.e., HIV, HCV, and overdoses [ODs]) are shifting from cities to rural areas; rural young adults (YA) are bearing the brunt of these epidemiologic transitions. The recent HIV outbreak in rural Indiana testifies to the crises these transitions can create. Science, however, has failed to keep pace with these seismic shifts. 15 years after NMPO use began to surge in rural areas, we know little about patterns or determinants of NMPO use, heroin use, HIV, HCV, and ODs among rural YAs. Studies of rural opioid users (regardless of age) have also been limited: with rare exception, this research has focused solely on individual-level predictors. A large body of research guided by the Risk Environment Model (REM) in cities, however, shows that vulnerability to drug use, HIV, and other harms is created by factors operating at multiple levels, including neighborhoods. Almost all methods and measures to study drug use and related harms were created for use in cities, and so developing a new generation of research on rural YA opioid users and their risk environments presents major methodologic and measurement challenges. Targeted sampling, respondent-driven sampling (RDS), and other methods created to recruit urban people who use drugs (PWUD) are most effective when population densities are high, environments are service rich, and public transportation links participants to study sites; these same (urban) features facilitate the in-person survey administration and biosample collection so common in studies of urban PWUD. These recruitment and data collection methods, however, founder in rural areas, which are sparsely populated, have few services for PWUD, and lack public transportation. Applying REM in rural areas also presents measurement challenges, in part because the geographic units at which data are available (e.g., census block groups) are much too large in rural areas to precisely characterize local environments. The proposed mixed-methods R21 study, led by a dual-PI team with rich complementary expertise, will lay the foundations for a new generation of theoretically informed, rigorous, reproducible, high-impact multilevel research on how risk environments influence NMPO and heroin use and HIV, HCV, and OD among YA in multiple US rural counties. It will lay these foundations by leveraging high levels of internet use in the target population and will achieve the following aims: Aim 1. To develop and test the feasibility of using (a) WebRDS, a virtual form of RDS, and (b) a virtual eligibility screener to create a sample (N=200) of YA opioid users in a rural epicenter of NMPO use, heroin use, and related harms (Rowan County, KY). Aim 2. To create and validate novel survey-based and virtual geospatial measures of features of rural risk environments. Aim 3. To develop and pilot (a) an internet survey of the rural risk environment; drug use patterns; HIV and HCV risk; and OD risk and occurrence in the sample; and (b) a system of home-based HIV testing in a subsample. Aim 3.1. To analyze Aim 3 data to inform power calculations for this new generation of high-impact multilevel research.