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

摘要：非医用处方阿片类药物(NMPO)的使用、海洛因的使用和与药物相关的危害(即， 艾滋病毒、丙型肝炎病毒和过量用药)正在从城市转移到农村地区；农村年轻人(YA)正在承受 首当其冲的是这些流行病的转变。最近在印第安纳州农村爆发的艾滋病毒证明了这些危机 过渡可以创造。然而，科学未能跟上这些巨变的步伐。15年后 NMPO的使用在农村地区开始激增，我们对NMPO的使用模式或决定因素--海洛因--知之甚少 农村雅雅族人群中艾滋病、丙型肝炎病毒和药物使用情况。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，这项研究只关注个人层面的预测因素。一大堆 然而，在城市风险环境模型(REM)指导下的研究表明，对药物使用的脆弱性， 艾滋病毒和其他危害是由包括社区在内的多个层面上的因素造成的。几乎所有的 研究毒品使用和相关危害的方法和措施被创造出来，供城市使用，并因此发展 新一代农村阿片类药物使用者及其风险环境研究呈现主要 方法学和测量方面的挑战。定向抽样、受访者驱动抽样(RDS)和其他 为招募城市吸毒者而创建的方法(PWUD)在人口密度较高时最有效 高，环境服务丰富，公共交通将参与者连接到学习地点；这些都是相同的 (城市)功能便于面对面的调查管理和生物样本收集，这在研究中非常常见 城市PWUD。然而，这些招聘和数据收集方法在农村地区成立，它们是 人口稀少，为残疾人提供的服务很少，而且缺乏公共交通。REM在农村地区的应用 还存在测量挑战，部分原因是数据可用的地理单位(例如， 人口普查区组)在农村地区太大，无法准确地描述当地环境。 拟议的混合方法R21研究将由一个具有丰富互补专业知识的双PI团队领导，将 为新一代理论上知情、严谨、可重现、高影响的多层次 危险环境对青年人群NMPO、海洛因使用及HIV、HCV、OD影响的研究 美国多个农村县。它将通过在目标地区利用高水平的互联网使用来奠定这些基础 将实现以下目标：目标1.开发和测试使用(A)WebRDS的可行性， RDS的虚拟形式，以及(B)虚拟资格筛查，以创建YA阿片使用者的样本(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.创造和 验证新的基于调查和虚拟地理空间的农村风险环境特征测量方法。目标3.至 制定和试点(A)关于农村风险环境、药物使用模式、艾滋病毒和丙型肝炎病毒风险的互联网调查；以及 样本中的吸毒风险和发生情况；和(B)亚样本中以家庭为基础的艾滋病毒检测系统。目标3.1。 分析Aim 3的数据，为这一新一代高影响多水平研究的功率计算提供信息。

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.