Buprenorphine, Hepatitis C Virus and Their Relationship in Rural US Populations

项目摘要 美国农村地区正面临阿片类药物使用障碍（OUD）和肝炎的流行 丙型肝炎病毒（HCV）感染。HCV是一种高发病率和高死亡率的昂贵感染， 注射毒品在美国注射吸毒是流行病的比例， 从滥用口服阿片类药物过渡到注射形式的阿片类药物。注射者中的HCV 药物（PWID）可以通过处方药物辅助治疗OUD来预防，例如 丁丙诺啡然而，在OUD和HCV感染率高的农村人群中，这种关系尚不清楚， 但丁丙诺啡的可及性很低我们的初步研究还表明， 基于农村地区与丁丙诺啡相关的处方习惯。农村社区领导人要求 进行调查这项调查可以为农村人口的做法和政策提供信息， 受到当前阿片类药物危机的严重影响。 本研究的具体目的是1）描述丁丙诺啡处方的差异 2012-2017年美国城市和农村人口之间的关系2）评估获得 2014-2017年俄亥俄州农村地区的丁丙诺啡和HCV处方，以及3）评估 在使用丁丙诺啡的人群中， 2019年美国农村人口中的药物（PWUD）。目标1是由来自以下方面的初步定性数据提供信息的- 与社区利益相关者进行深入访谈，并将作为大数据医疗保健索赔调查， 丁丙诺啡如何在农村地区不太常见和使用时间较短。目标2是一个 农村丁丙诺啡处方者与丙型肝炎发病关系的生态空间分析 地区目标3是在俄亥俄州农村进行的一项主要受试者驱动的PWID抽样调查。目标3是一个独特的PWID- 获得和使用处方丁丙诺啡与HCV感染之间关系的观点 农村人口的发病率。 这些目标中的每一个都与当地（俄亥俄州）传染病诊所的纵向跟踪相结合 州）和农村俄亥俄州（南俄亥俄州医疗中心）。此外，我们还制定了培训计划， 将提供独特的技能，否则无法在目前的流行病学博士或医学培训 程序.我计划在传染病领域成为一名独立资助的医生兼科学家 流行病学和临床医学。我还计划将我的研究和临床工作重点放在农村人口上 就像那些在南俄亥俄州，靠近我长大的地方，不成比例地受到注射毒品的影响。 社区驱动的循证干预措施，结合专门的保健和公共卫生 需要医生来结束目前的阿片类药物危机。

PROJECT SUMMARY Rural areas in the United States (US) are facing an epidemic of opioid use disorder (OUD) and hepatitis C virus (HCV) infections. HCV is a costly infection with high morbidity and mortality and is primarily spread through injection drugs use in the US. Injection drug use is of epidemic proportions as people with OUD transition from misusing oral opioid medications to injectable forms of opioids. HCV among people who inject drugs (PWID) may be preventable through prescribed medication-assisted treatments for OUD, such as buprenorphine. However, this relationship is unclear in rural populations where OUD and HCV rates are high, but access to buprenorphine is low. Our preliminary studies also indicate marked stigma and non-evidence based prescribing habits associated with buprenorphine in rural areas. Rural community leaders have asked for this investigation. This investigation can inform practices and policies on rural populations that are disproportionately affected by the current opioid crisis. The specific aims of this research are 1) to describe differences in buprenorphine prescribing between urban and rural US population, 2012-2017 2) to assess the relationship between access to prescribed buprenorphine and HCV in rural Ohio, 2014-2017 and 3) to assess the relationship between perceived access to and use of prescribed buprenorphine with HCV status among people who use drugs (PWUD) in a rural US population in 2019. Aim 1 is informed by preliminary qualitative data from in- depth interviews with community stakeholders and will serve as a big data health care claims investigation of how buprenorphine may be prescribed less commonly and for shorter periods in rural areas. Aim 2 is an ecological spatial analysis of the relationship between buprenorphine prescribers and incident HCV in rural areas. Aim 3 is a primary respondent-driven sampling survey of PWID in rural Ohio. Aim 3 is a unique PWID- perspective of the relationship between access and use of prescribed buprenorphine and HCV infection incidence in rural populations. Each of these aims is coupled with longitudinal shadowing in infectious disease clinics locally (Ohio State) and in rural Ohio (Southern Ohio Medical Center). Additionally, we have developed a training plan that will provide unique skills otherwise not available in the current epidemiology doctoral or medical training program. I plan to have a career as an independently funded physician-scientist in infectious disease epidemiology and clinical medicine. I also plan to focus my research and clinical efforts on rural populations like those in Southern Ohio, near where I grew up, that are disproportionately impacted by injection drug use. Community-driven evidence-based interventions, in conjunction with dedicated health care and public health practitioners, are needed to end the current opioid crisis.