Oregon HIV/Hepatitis and Opioid Prevention and Engagement (OR-HOPE) Study Cost Extension

项目摘要 俄勒冈州的艾滋病毒/肝炎和阿片类药物预防和参与（OR-HOPE）研究是一项两个- 第三阶段（UG 3和UH 3），多方法研究，以实施社区行动小组和农村同行 在阿片类药物过量、肝炎高风险的俄勒冈州农村县进行护理协调员干预 C、艾滋病。这项研究利用了现有的和发展中的公共卫生和治疗 建立基础设施，以实施可持续的农村同伴护理协调员模式。在阶段1中 (UG3)，我们建立社区行动小组，审查和制定当地社区的反应， 计划在两个高需求的农村县解决户外发展问题及其后果。焦点小组和 与社区利益攸关方（初级保健提供者、公共卫生 官员、执法人员和受影响的社区成员）记录需求、资源， 确定实施应对计划的最佳做法。我们还评估了一个 PCC干预，以改善艾滋病毒，丙型肝炎检测和联系，以照顾OUD的人， 并将确认的静脉切开术送到疾控中心和幽灵实验室伴随的远程保健 干预支持初级保健提供者治疗OUD和丙型肝炎患者。 1期（UG 3）里程碑包括：1）制定社区响应计划，2）招募 初级保健提供者的远程保健支持，3）试点实施PCC干预， 4)参与者采血样本成功发送至CDC/GHOST实验室。在第二阶段，我们扩展- 将PCC干预措施扩大到8个农村县，以评估PCC在改善 艾滋病毒和丙型肝炎检测，阿片类药物过量，以及与艾滋病毒，丙型肝炎和 阿片类药物使用障碍逐步楔形实施设计包括尚未启动的县 干预作为时间控制。主要结果是1）艾滋病毒检测次数 在干预县和非干预县进行比较。次要结果包括a） 药物过量率，B）开始HIV治疗，c）开始HCV治疗，d）开始OUD 治疗，e）一年时的HIV病毒抑制，和f）丙型肝炎持续的病毒应答。 在第2阶段中继续进行的定性利益相关者访谈记录了挑战和最佳做法 PCC干预和社区应对计划实施的实践。结果通知 开发新的和可持续的社区干预模式，以减少OUD及其 美国农村的后果。拟议的工作与NIH艾滋病研究办公室保持一致 扩大艾滋病毒检测和参与治疗以及艾滋病毒治疗的优先事项 合并症。

Project Summary The Oregon HIV/Hepatitis and Opioid Prevention and Engagement (OR-HOPE) study is a two- phase (UG3 & UH3), multi-method study to implement community action teams and a peer rural care coordinator intervention in rural Oregon counties at high risk for opioid overdose, hepatitis C, and HIV. The study leverages existing and developing public health and treatment infrastructure to implement a sustainable rural peer care coordinator (PCC) model. In Phase 1 (UG3), we develop community action teams that review and develop local community response plans to address OUD and its consequences in 2 high-needs rural counties. Focus groups and qualitative interviews with community stakeholders (primary care providers, public health officials, law enforcement, and affected community members) document needs, resources, and identify best practices for response plan implementation. We also assess the feasibility of a PCC intervention to improve HIV, hepatitis C testing and linkage to care for people with OUD, and sending confirmatory phlebotomy to CDC/GHOST lab. A concomitant telehealth intervention supports primary care providers in treatment of patients with OUD and hepatitis C. Phase 1 (UG3) milestones include: 1) development of community response plans, 2) enrollment of primary care providers in telehealth support, 3) pilot implementation of PCC intervention, and 4) participant phlebotomy samples successfully sent to CDC/GHOST lab. In Phase 2, we scale- up the PCC intervention to 8 rural counties to assess the effectiveness of PCCs in improving HIV and hepatitis C testing, opioid overdose, and linkage to treatment for HIV, hepatitis C, and opioid use disorder. The step-wedge implementation design includes counties not yet initiating the intervention to serve as temporal controls. The primary outcome is 1) number of HIV tests performed in intervention versus non-intervention counties. Secondary outcomes include a) overdose rates, b) initiation of HIV treatment, c) initiation of HCV treatment, d) initiation of OUD treatment, e) HIV viral suppression at one year, and f) hepatitis C sustained viral response. Continued qualitative stakeholder interviews in Phase 2 document challenges and best practices for PCC intervention and community response plan implementation. The results inform development of novel and sustainable community intervention models to decrease OUD and its consequences in rural America. The proposed work aligns with NIH Office of AIDS Research priorities of expanding HIV testing and engagement in treatment, and treatment of HIV comorbidities.