Drug Injection Surveillance and Care Enhancement for Rural Northern New England (DISCERNNE)

新英格兰北部农村地区的药物注射监测和护理加强 (DISCERNNE)

• 批准号: 10644443
• 负责人: Peter D Friedmann
• 金额: $ 14.8万
• 依托单位: BAYSTATE MEDICAL CENTER, INC.
• 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 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10644443
• 关键词: Address; Administrative Supplement; Aftercare; Attention; Back; Behavior; Blood; COVID-19; COVID-19 pandemic; COVID-19 testing; Caring; Communities; Consent; County; Disease Outbreaks; Effectiveness; Emergency department visit; Employee; Enrollment; Environment; Epidemiology; Funding; HIV; Harm Reduction; Health Personnel; Health system; Healthcare; Hepatitis A Vaccines; Hepatitis A Virus; Hepatitis B Vaccination; Hepatitis B Virus; Hepatitis C; Hepatitis C Antibodies; Hepatitis C Therapy; Hepatitis C Viremia; Hepatitis C virus; Injecting drug user; Injections; Institution; Intervention; Laboratories; Legal; Massachusetts; Medical; Modeling; Natural Disasters; Needle Sharing; New England; New Hampshire; Opioid; Overdose; Participant; Pharmaceutical Preparations; Phase; Provider; Public Health; Randomized; Reporting; Resources; Risk; Risk Behaviors; Running; Rural; Rural Community; Services; Sexually Transmitted Diseases; Spottings; Syringes; Taxes; Telemedicine; Testing; Time; Training; Travel; Validation; Venous blood sampling; Vermont; Viral; Viral Load result; Work; authority; care seeking; comorbidity; cost; effectiveness implementation study; follow-up; formative assessment; health related quality of life; high risk; opioid epidemic; opioid injection; opioid use; opioid use disorder; pandemic disease; primary outcome; response; rural America; rural area; rural counties; secondary outcome; substance use; surveillance strategy; telehealth; treatment as usual

ABSTRACT In New England’s rural areas, the epidemic of opioid use disorder (OUD) and its related conditions: overdose, HIV, hepatitis C virus (HCV), sexually transmitted infections (STIs) and other infectious comorbidities present the most substantial challenges to public health and health care in decades. The Drug Injection Surveillance and Care Enhancement for Rural Northern New England (DISCERNNE) study examined the epidemiology of opioid use, its infectious consequences, and service accessibility in rural counties along the Interstate 91 corridor in Massachusetts, New Hampshire and Vermont. Our initial work (UG3) found that syringe-sharing and HCV are highly prevalent, while access to clean syringes, phlebotomy services, HCV testing and treatment are limited placing these counties at high risk for a Scott County-like HIV outbreak. Other relevant lessons learned from the UG3 phase include: (1) any intervention must limit the burden on the local harm reduction and medical institutions that have limited space and resources for new programming and are straining to meet their current responsibilities; and (2) any intervention must account for the reluctance of active PWIDs to seek care from a health system that has treated them poorly. In the second phase of the DISCERNNE study (UH3), we are working closely with harm reduction experts in these rural communities to deploy a mobile syringe services van to expand HCV antibody and viral testing, bolster syringe access, and provide HCV telemedicine treatment. Study participants with HCV antibody present will undergo testing for HCV viremia, and, as appropriate, receive initial hepatitis B virus (HBV) and/or hepatitis A virus (HAV) vaccines. Participants (n= 220) are randomized to one of two strategies for HCV treatment:  Enhanced Usual Care (EUC) – referral with care navigation to an HCV treatment provider.  Mobile tele-HCV Care (MTC) – telemedicine Direct-Acting Antiviral treatment for HCV (DAA) on the van. If effective, this mobile model of HCV telehealth integrated with syringe services will provide a promising approach for local public health authorities seeking to curb opioid injection, syringe sharing and HCV rates in rural America, and reduce the risk environment for HIV outbreaks in those communities. An administrative supplement is requested to offset an increase in project costs and challenges related to the Covid-19 pandemic.

摘要 在新英格兰的农村地区，阿片类药物使用障碍(OUD)的流行及其相关情况： 吸毒过量、艾滋病毒、丙型肝炎病毒(丙型肝炎病毒)、性传播感染(STI)和其他传染病 合并症是几十年来公共卫生和卫生保健面临的最大挑战。《毒品》 新英格兰北部农村地区注射监测和加强护理(DISCERNNE)研究被审查 阿片类药物使用的流行病学、感染后果和服务可获得性 马萨诸塞州、新罕布夏州和佛蒙特州的91号州际公路走廊。我们最初的工作(UG3)发现 共用注射器和丙型肝炎病毒非常普遍，而获得清洁注射器、抽血服务和丙型肝炎病毒 检测和治疗有限，使这些县面临类似斯科特县的艾滋病毒爆发的高风险。其他 从普遍定期审议阶段吸取的相关经验教训包括：(1)任何干预措施都必须限制地方政府的负担 减少危害和医疗机构，用于新的规划的空间和资源有限，并且 努力履行他们目前的责任；以及(2)任何干预都必须解释为什么 积极的残疾人向对待他们很差的卫生系统寻求护理。 在DISCERNNE研究的第二阶段(UH3)，我们正在与减少危害密切合作 这些农村社区的专家部署了一辆流动注射器服务车来扩大丙型肝炎病毒抗体和病毒 测试，加强注射器通路，并提供丙型肝炎病毒远程医疗治疗。携带丙型肝炎病毒抗体的研究参与者 将接受丙型肝炎病毒血症检测，并在适当的情况下接受初步的乙肝病毒(乙肝)和/或 甲型肝炎病毒(HAV)疫苗。参与者(n=220)被随机分成两种治疗丙型肝炎病毒的方案之一。 治疗： 丙型肝炎病毒增强的日常护理()-转诊与护理导航到丙型肝炎治疗提供者。 移动远程丙型肝炎护理(MTC)-远程医疗直接作用抗病毒治疗(DAA)在面包车上。 如果有效，这种将丙型肝炎病毒远程医疗与注射器服务相结合的移动模式将提供一种有前景的 年，地方公共卫生当局寻求控制阿片类药物注射、共用注射器和丙型肝炎病毒感染率的方法 减少这些社区中艾滋病毒暴发的风险环境。行政管理人员 要求追加资金，以抵消项目成本的增加和与新冠肺炎有关的挑战 大流行。