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

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。在这12个县中，有10个县在艾滋病毒/HCV脆弱性方面排名前5%。HCV感染率，注射 毒品使用（IDU）和吸毒过量在这些县很高，大多数是在煤炭国家，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。 这些县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UG3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)选择符合当地需求和优势的EB-CRP， 使用干预映射的元素。进行/不进行里程碑：每个CAP将创建一个EB-CRP 一揽子计划，（1）解决所有国家共同的目标（例如，阿片样物质注射，OD，HCV，HIV），和（2） 根据当地需求、资源和准备情况量身定制。在UH3中，我们将：（4）为每个 县的背景下使用ADAPT-ITT。(5)分析每个县的EB-CRP包的有效性和成本， 使用一个创新的社区随机试验。我们将通过持续的质量改进， EB-CRP的保真度，范围，即时效果和结果。为了提供干预信息，先进的网络 分析将覆盖具有GHOST系统发育传播数据的风险网络，以显示HCV在哪里传播。 并预测它的走向。我们从合作中汲取力量。CAP将融合居民的当地 知识与研究人员的科学专长。多PI杨和库珀已经组装了一个学术 在关键物质、理论和方法以及多地点研究方面拥有无与伦比的专业知识的团队。的 严谨、创新的设计、强大的理论和具有社区根基的一流团队的结合， 确保高影响力。

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 of these 12 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 an EB-CRP 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-CRP to each county’s context using ADAPT-ITT. (5) Analyze the effectiveness and cost of each county’s EB-CRP package, using an innovative community randomized trial. 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, strong theories, and a stellar team with community roots will ensure high impact.