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

项目总结 美国农村地区正面临阿片类药物使用障碍和肝炎的流行 丙型肝炎病毒(丙型肝炎)感染。丙型肝炎病毒是一种代价高昂的感染，发病率和死亡率都很高，主要是通过 通过注射毒品在美国使用。注射毒品的使用是流行的比例，因为OUD的人 从滥用口服阿片类药物过渡到注射形式的阿片类药物。注射人群中的丙型肝炎病毒 药物(PWID)可通过处方药物辅助治疗预防，例如 丁丙诺啡。然而，这种关系在乌德和丙型肝炎感染率较高的农村人口中尚不清楚， 但丁丙诺啡的获得性很低。我们的初步研究也表明明显的污名和没有证据 基于农村地区丁丙诺啡的处方习惯。农村社区领袖要求 为了这次调查。这项调查可以为有关农村人口的做法和政策提供信息，这些做法和政策 不成比例地受到当前阿片类药物危机的影响。 本研究的具体目的是：1)描述丁丙诺啡处方的差异 美国城市和农村人口之间的关系，2012-2017 2)评估获得 2014-2017年俄亥俄州农村地区开出的丁丙诺啡和丙型肝炎病毒之间的关系 吸毒者对丙型肝炎病毒状态的丁丙诺啡处方的知觉接触和使用 2019年美国农村人口中的毒品(PWUD)。AIM 1由来自in-in的初步定性数据提供信息- 与社区利益相关者进行深度访谈，并将作为对医疗保健索赔的大数据调查 丁丙诺啡如何在农村地区不那么普遍和更短的时间内被开出。目标2是一个 丁丙诺啡处方使用者与农村丙型肝炎发病关系的生态空间分析 区域。AIM 3是俄亥俄州农村地区以主要受访者为主导的PWID抽样调查。AIM 3是一个独特的PWID- 丁丙诺啡处方获得和使用与丙型肝炎病毒感染关系的研究 农村人口中的发病率。 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 俄亥俄州)和俄亥俄州农村(南俄亥俄州医疗中心)。此外，我们还制定了一项培训计划 将提供目前流行病学、博士或医学培训中没有的独特技能 程序。我计划成为一名独立资助的传染病内科科学家。 流行病学和临床医学。我还计划将我的研究和临床努力集中在农村人口上 像俄亥俄州南部的那些人，离我长大的地方很近，他们受到注射毒品的影响不成比例。 社区驱动的循证干预，与专门的医疗保健和公共卫生相结合 需要从业者，以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.