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

检查社会对有艾滋病毒风险的农村吸毒者更换注射器的影响

• 批准号: 9481503
• 负责人: HILARY L SURRATT
• 金额: $ 23.06万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-30 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9481503
• 关键词: AIDS prevention; Acute Hepatitis C; Appalachian Region; Area; Centers for Disease Control and Prevention (U.S.); Communities; County; Data; Disease Outbreaks; Drug usage; Drug user; Economics; Epidemic; Geography; Growth; HIV; HIV risk; HIV/HCV; Health; Health Personnel; Health Services Accessibility; Heroin; Hour; Indiana; Infection; Injectable; Injecting drug user; Injection of therapeutic agent; Intervention; Interview; Justice; Kentucky; Knowledge; Law Enforcement; Location; Methods; Modeling; Morbidity - disease rate; Needle-Exchange Programs; Opioid; Overdose; Pattern; Perception; Persons; Pharmaceutical Preparations; Pike fish; Policies; Population; Prevention strategy; Preventive Intervention; Privacy; Program Accessibility; Public Health; Public Policy; Recommendation; Research; Resources; Risk; Risk Behaviors; Risk Factors; Rural; Rural Community; Sampling; Services; Social Characteristics; Social Values; Social isolation; Structure; Syringes; System; Time; aged; disorder prevention; evidence base; experience; high risk; improved; injection drug use; mortality; peer; prescription opioid; prescription opioid abuse; rural area; social; social norm; social stigma; stressor; substance abuse treatment; theories; uptake; virtual

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.

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 影响注射者对新实施的注射器交换计划的接受 药物（PWID）在农村阿巴拉契亚肯塔基州（KY）。在这个资源贫乏的农村地区， 这一领域提供了一个独特的机会，可以检查影响循证结构性 在高度脆弱和未得到充分研究的艾滋病感染者群体中开展艾滋病毒预防干预， 制定补充性干预战略，以提高SEP的利用率。严重的健康后果 与阿片类药物注射相关的疾病处于危机水平：肯塔基州的急性丙型肝炎（HCV）发病率最高， 特别是居住在非城市地区的年龄≤30岁的人， 吸毒此外，疾病预防控制中心最近的一项分析确定，肯塔基州阿巴拉契亚的8个县是 全国前10名最容易在PWID中快速传播艾滋病毒和丙型肝炎病毒。尽管- 尽管有记录表明，在药物使用模式和社会特征方面存在着城乡差异，但在我们的研究中， 了解农村社区残疾人接受和利用可持续教育方案的社会驱动因素。的 在农村地区，几乎没有执行结构性的艾滋病毒预防方案， 城市SEPs研究结果的适用性在很大程度上是未知的。迫切需要这些数据， 为继续完善公共教育部针对弱势农村残疾人的政策和做法提供信息，并制定 补充性的多层次预防战略，以加强农村地区自雇人士的获得和利用。 在社会生态学理论的指导下，本研究的具体目标是：1） 检查三个阿巴拉契亚县HD（克拉克，诺克斯和派克）的SEP摄取，通过结构化 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 社会生态领域中的利用者和非利用者之间，包括个人内部（例如，HIV /HCV 知识，农村身份），人际（例如，亲属关系、同伴规范、社会隔离）;制度性（例如，司法 系统参与，执法活动）;社区（例如，社区耻辱、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; 2）确定优先干预措施 目标和制定战略，以提高农村残疾人对SEPs的接受率， 从目标1中战略性地选择PWID样本进行定性访谈， 部门主管和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，并制定干预优先事项和实践建议 改善SEP摄取的变化。