Examining Social Influences on Syringe Exchange Uptake among Rural PWID at Risk for HIV

拟议的研究将进行有针对性的形成性研究，以确定关键的社会生态因素。 影响新实施的注射器交换计划(SEP)在注射人群中的应用 阿巴拉契亚肯塔基州(肯塔基州)农村的毒品(PWID)。最近在这个资源匮乏的农村地区启动了SEPS Area提供了一个独特的机会来检查影响基于证据的结构的采纳的社会驱动因素 在高度脆弱和研究不足的PWID人群中进行艾滋病毒预防干预，并 制定补充干预策略，以提高SEP利用率。严重的健康后果 与阿片类药物注射相关的是处于危机水平：肯塔基州的急性丙型肝炎(丙型肝炎)发生率在 全国，特别是在居住在非城市地区的30岁的≤人群中，有注射危险因素的人群 吸毒。此外，疾控中心最近的一项分析确定，肯塔基州阿巴拉契亚地区的8个县属于 在PWID中，全国最容易受到艾滋病毒和丙型肝炎病毒快速传播的前十名。尽管如此- 有据可查的城乡吸毒模式和社会特征的差异，在我们的 农村社区残疾人对SEP吸收和利用的社会驱动因素的了解这个 在农村地区几乎没有实施结构层面的艾滋病毒预防方案，以及 城市SEPS的研究结果的适用性在很大程度上是未知的。迫切需要这样的数据来 告知继续完善针对弱势农村残疾人的SEP政策和做法，并制定 补充的多层次预防战略，以加强农村地区SEP的获取和利用。 在社会生态学理论的指导下，本探索性混合方法研究的具体目的是：1) 检查三个阿巴拉契亚县HDS(克拉克、诺克斯和派克)对SEP的吸收情况 与350名PWID(175名SEP使用者和175名非使用者)进行访谈，以确定和比较关键差异 社会生态领域的利用者和非利用者之间的关系，包括个人内部(例如艾滋病毒/丙型肝炎病毒 知识、农村身份)、人际关系(例如，亲属关系、同伴规范、社会隔离)、体制(例如，司法 系统参与、执法活动)；社区(例如社区污名、地理距离)；以及 公共政策因素(例如，SEP政策和实践(隐私/匿名、时间、地点、分发模式、 二次交换))影响SEP吸收和利用；以及，2)确定优先干预措施 目标和制定战略，通过深入开展，提高农村残疾人对SEP的接受程度 对Aim 1战略选择的PWID样本以及关键健康状况进行定性访谈 部门主任和SEP工作人员、当地物质治疗提供者、执法部门和其他 社区利益相关者，以评估SEP利用的多层次障碍、可接受性和可行性 补充干预战略，并就干预优先事项和做法提出建议 改善SEP摄取的变化。

The proposed study will conduct targeted formative research to identify key social-ecological factors influencing the uptake of newly implemented syringe exchange programs (SEPs) among people who inject drugs (PWID) in rural Appalachian Kentucky (KY). The recent initiation of SEPs in this rural, resource poor area provides a unique opportunity to examine social drivers impacting uptake of an evidence-based structural level HIV prevention intervention among a highly vulnerable and understudied population of PWID, and to develop complementary intervention strategies for enhancing SEP utilization. Serious health consequences associated with opioid injection are at crisis levels: KY has the highest rate of acute hepatitis C (HCV) in the nation, particularly among persons aged ≤30 years residing in non-urban areas, with a risk factor of injection drug use. In addition, a recent analysis by the CDC identified 8 counties in Appalachian KY as among the nation's top 10 most vulnerable to the rapid dissemination of HIV and HCV among PWID. Despite well- documented rural-urban differences in drug use patterns and social characteristics, there is a critical gap in our knowledge of social drivers of SEP uptake and utilization among PWID in rural communities. The implementation of structural level HIV prevention programming has been virtually absent in rural locations, and the applicability of research findings from urban SEPs is largely unknown. Such data are urgently needed to inform the continued refinement of SEP policies and practices for vulnerable rural PWID and to develop complementary multi-level prevention strategies to enhance access and utilization of rurally located SEPs. Guided by Social Ecological Theory, the Specific Aims of this exploratory mixed methods study are to: 1) Examine the uptake of SEPs in three Appalachian county HDs (Clark, Knox and Pike), through structured interviews with 350 PWID (175 SEP utilizers and 175 non-utilizers) to identify and compare the key differences between utilizers and non-utilizers in social ecological domains, including intrapersonal (e.g., HIV /HCV knowledge, rural identity), interpersonal (e.g., kinship, peer norms, social isolation); institutional (e.g., justice system involvement, law enforcement activity); community (e.g., community stigma, geographic distance); and public policy factors (e.g., SEP policies and practices (privacy/anonymity, hours, locations, distribution model, secondary exchange)) that influence SEP uptake and utilization; and, 2) Identify priority intervention targets and develop strategies to enhance uptake of SEPs among rural PWID, by conducting in-depth qualitative interviews with a strategically selected sample of PWID from Aim 1, as well as key health departments directors and SEP staff, local substance treatment providers, law enforcement, and other community stakeholders, to assess multi-level barriers to SEP utilization, acceptability and feasibility of complementary intervention strategies, and to develop recommendations for intervention priorities and practice changes to improve SEP uptake.