Kentucky Communities and Researchers Engaging to Halt the Opioid Epidemic (CARE2HOPE)

肯塔基州社区和研究人员致力于制止阿片类药物的流行 (CARE2HOPE)

• 批准号: 9760236
• 负责人: Hannah LF Cooper
• 金额: $ 149.93万
• 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: 2017-08-15 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9760236
• 关键词: Address; Appalachian Region; Area; Behavioral; Caring; Centers for Disease Control and Prevention (U.S.); Cities; Coal; Collaborations; Communities; Community Trial; Country; County; Disease Outbreaks; Drug user; Effectiveness; Elements; Ensure; Environment; Epidemic; Epidemiologic Methods; Epidemiology; Evidence based intervention; General Population; HIV; HIV/HCV; Harm Reduction; Health; Health Services; Hepatitis C virus; Heroin; Incidence; Infrastructure; Injecting drug user; Injections; Intervention; Kentucky; Knowledge; Laws; Letters; Methods; Modeling; Naloxone; National Institute of Drug Abuse; Needle-Exchange Programs; Outcome; Overdose; Pathway Analysis; Pharmaceutical Preparations; Phylogenetic Analysis; Plant Roots; Policies; Prescription opioid overdose; Provider; Public Health; Qualitative Research; Readiness; Research Infrastructure; Research Personnel; Resources; Risk; Risk Assessment; Rivers; Rural; Rural Appalachia; Services; Site; Substance Use Disorder; Testing; United States Substance Abuse and Mental Health Services Administration; Unsafe Sex; Work; base; combat; community based participatory research; cost effectiveness; data exchange; design; evidence base; implementation science; improved; infectious disease treatment; injection drug use; innovation; mathematical model; member; misuse of prescription only drugs; opioid epidemic; opioid injection; prescription opioid; randomized trial; response; rural counties; social stigma; theories; virtual

Abstract: The proposed project will build evidence-based, community-rooted public health responses to the epidemics of non-medical prescription opioid (NMPO) and heroin injecting, overdoses (ODs), and HCV, and to imminent HIV outbreaks, in 12 rural Appalachian Kentucky counties at the epicenter of these intertwined national crises. 10 counties rank in the top 5% for HIV/HCV vulnerability. Rates of HCV, injection drug use (IDU), and ODs are high in these counties, and most are in coal country, an RFA priority. Unfortunately, these counties exemplify an extreme version of the “implementation chasm,” a chasm dividing scientific knowledge from action. Evidence-based public health responses to these epidemics exist (e.g., syringe service programs [SSPs]) and are often deployed in cities. In these 12 rural counties, though, scarcities of resources and of providers conspire with drug-related stigma to constrain public health responses. The counties' public health infrastructures are weak, their harm reduction infrastructures virtually non-existent. This project will bridge the implementation chasm in these 12 counties, and recognizes that bridging this chasm requires more than simply importing SSPs and other evidence-based community response projects (EB-CRPs) from cities. Guided by harm reduction principles, the Risk Environment Model, and Community/ Academic Partnerships (CAPs), in the UG3 we will: (1) Assess and enhance each county's readiness to improve the local risk environment. (2) Examine the strengths, resources, needs, and gaps of each county's risk environment. We will conduct a multi-method Community Assessment of the Risk Environment that integrates innovative, rigorous epidemiology (e.g., modeling); policy assessment; and best practices in community-based research (e.g., CAPs). (3) Select a package of EB-CRPs that responds to local needs and strengths, using elements of Intervention Mapping. Go/no go milestone: Each CAP will have created an EB- CRP package that (1) addresses targets common across all counties (e.g., opioid injection, OD, HCV, HIV), and (2) is tailored to local needs, resources, and readiness. In the UH3, we will: (4) Tailor selected EB-CRPs to each county's context using ADAPT-ITT. (5) Analyze the effectiveness and cost-effectiveness of each county's EB-CRP package, using an innovative stepped-wedge community randomized trial and mathematical models. We will use continuous quality improvement to enhance each EB-CRP's fidelity, reach, immediate effects, and outcomes. To inform interventions, advanced network analyses will overlay risk networks with GHOST phylogenetic transmission data to show where HCV has been and predict where it is going. We draw strength from our collaborations. CAPs will meld residents' local knowledge with researchers' scientific expertise. Multi- PIs Young and Cooper have assembled an academic team with unsurpassed expertise in key substance, theories, and methods, and in multisite studies. The combination of a rigorous, innovative design (e.g., step- wedge community trials), strong theories, and a stellar team with community roots will ensure high impact.

翻译后摘要：拟议的项目将建立以证据为基础的，以社区为基础的公共卫生反应， 非医疗处方阿片类药物（NMPO）和海洛因注射、过量（ODs）和HCV的流行，以及 即将爆发的艾滋病毒，在12个农村阿巴拉契亚肯塔基州县在这些交织的震中 国家危机。10个县在艾滋病毒/丙型肝炎病毒脆弱性方面排名前5%。HCV感染率，注射吸毒 (IDU)这些县的OD很高，大多数都在煤炭国家，这是RFA的优先事项。 不幸的是，这些国家面临着“实施鸿沟”的极端版本， 将科学知识与行动分开。对这些流行病采取了循证公共卫生对策 (e.g.,注射器服务计划[SSP]），并经常部署在城市。然而，在这12个农村县， 资源和提供者的匮乏，加上与毒品有关的污名，限制了公共卫生对策。 各州的公共卫生基础设施薄弱，减少危害的基础设施几乎不存在。 该项目将弥合这12个州的执行差距，并认识到弥合这一差距 鸿沟需要的不仅仅是简单地引进SSP和其他基于证据的社区响应项目 （EB-CRP）从城市。在减少危害原则、风险环境模型和社区/ 学术合作伙伴关系（CAP），在UG 3中，我们将：（1）评估和加强每个国家的准备， 改善当地风险环境。(2)检查每个县的优势、资源、需求和差距， 风险环境。我们将对风险环境进行多种方法的社区评估， 整合了创新的，严格的流行病学（例如，建模）;政策评估;以及 基于社区的研究（例如，CAPs）。(3)选择一套符合当地需求的EB-CRP， 优势，使用干预映射的元素。去/不去里程碑：每个CAP都将创建一个EB-1。 CRP一揽子计划，（1）解决所有国家的共同目标（例如，阿片样物质注射、OD、HCV、HIV）， （2）适合当地的需求、资源和准备情况。在UH 3中，我们将：（4）定制选定的EB-CRP， 每个国家的背景下使用ADAPT-ITT。(5)分析每个县的有效性和成本效益 EB-CRP包，采用创新的阶梯楔形社区随机试验和数学模型。 我们将使用持续的质量改进，以提高每个EB-CRP的保真度，覆盖面，即时效果， 结果。为了提供干预信息，高级网络分析将覆盖GHOST风险网络 系统发育传播数据，以显示丙型肝炎病毒已在哪里，并预测它的去向。我们汲取力量 从我们的合作。CAP将把居民的当地知识与研究人员的科学专长结合起来。多- 私家侦探杨和库珀组建了一个学术团队，在关键内容方面拥有无与伦比的专业知识， 理论和方法，以及多地点研究。结合严谨、创新的设计（例如，步骤- 楔形社区试验），强大的理论，和一个恒星团队与社区的根源将确保高的影响。