Vending machine Naloxone Distribution for Your community (VENDY): Increasing reach and implementation of naloxone distribution

项目摘要/摘要 去年，阿片类药物过量死亡人数增加了30%以上。旁观者访问 纳洛酮治疗有效逆转阿片类药物过量死亡，不良事件有限。但是，当前 纳洛酮的分配策略是阿片类药物过量的高风险失踪者。自动售货机是 显示了一项创新战略，以扩大欧洲减少伤害服务的覆盖范围。年轻的成年人 目击或经历过阿片类药物过量表达了对纳洛酮自动售货机的渴望，但确认 建筑环境的特征(包括安全和位置)作为影响使用的感知因素。那里 纳洛酮自动售货机在美国引起了广泛的兴趣。然而，实施挑战已经放缓 减少或限制采用，包括浏览利益相关者的批准并确定适当的位置 放置。这项建议的目的是研究社区发起的、利益相关者参与的适应 纳洛酮分销，自动售货机纳洛酮分销为您的社区(Vendy)，以增加 纳洛酮在有阿片类药物过量风险的服务不足人群中的覆盖范围。研究目标包括： 目标1：在3个服务不足的社区(2个城市和1个农村)使用 迭代的以用户为中心的设计(UCD)实施战略和利益相关者参与度 覆盖范围、实施和可持续性。我们将使用迭代可用性和消息测试来细化 与滥用阿片类药物的社区成员一起开展的计划。我们将进行调查和定性访谈 与利益攸关方共同完善UCD实施战略，以供未来使用。 目标2：在2个城市和1个农村社区对Vendy计划进行为期6个月的试点评估。 试点包括对覆盖范围、有效性、采用、实施进行中期调整和评估 和维护(RE-AIM)结果。 目标3：确定社会和建筑环境中有助于实现和实施 Vendy计划使用PhotoVoice对组织实施者和社区进行定性评估 目前正在使用阿片类药物的成员。PhotoVoice评估将在Aim 1的潜在地点进行，以告知 目标2中的Vendy位置和Vendy位置，以告知利益相关者的适应。 以社区为基础的方法，如Vendy，对于接触阿片类药物使用者尤其重要，目前还不是 与卫生系统打交道。为了实现这些目标，瓦格纳博士将进行以用户为中心的培训 设计，一种创新的执行战略，2)在不同环境中进行务实试验，3) 评估建筑和社会环境及其对REACH和实施的影响。这位导师 研究项目和职业发展计划旨在为瓦格纳博士成为 调整针对药物使用的有效干预措施，以更好地接触到服务不足的人群，并 产生可持续的实施模式。

PROJECT SUMMARY/ABSTRACT There has been more than a 30% increase in opioid overdose deaths in the last year. Bystander access to naloxone medication effectively reverses opioid overdose deaths with limited adverse events. However, current naloxone distribution strategies are missing individuals at high risk of opioid overdose. Vending machines are an innovative strategy shown to increase reach of harm reduction services in Europe. Young adults who witnessed or experienced an opioid overdose expressed a desire for naloxone vending machines but identified features of the built environment (including safety and location) as perceived factors contributing to use. There is widespread interest in naloxone vending machines in the U.S. Yet, implementation challenges have slowed down or limited adoption including navigating stakeholder approvals and identifying appropriate locations for placement. The aim of this proposal is to study a community-initiated, stakeholder engaged adaptation of naloxone distribution, VEnding machine Naloxone Distribution for Your community (VENDY), to increase the reach of naloxone in underserved populations at-risk of opioid overdose. Study Aims include: Aim 1: To refine the VENDY program in 3 underserved communities (2 urban and 1 rural) using an iterative user centered design (UCD) implementation strategy and stakeholder engagement to increase reach, implementation, and sustainability. We will use iterative usability and message testing to refine the program with community members who misuse opioids. We will conduct surveys and qualitative interviews with stakeholder to refine the UCD implementation strategy for future use. Aim 2: Conduct a 6 month pilot assessment of the VENDY program in 2 urban and 1 rural community. The pilot includes a midcourse adaptation and evaluation of reach, effectiveness, adoption, implementation and maintenance (RE-AIM) outcomes. Aim 3: Identify factors in the social and built environment contributing to reach and implementation of the VENDY program using photovoice qualitative evaluations with organization implementers and community members currently using opioids. Photovoice evaluations will occur in potential locations in Aim 1 to inform VENDY placement and in the VENDY location in Aim 2 to inform stakeholder adaptations. Community-based approaches such as VENDY are particularly important to reach opioid users not currently engaged with health systems. To accomplish these aims, Dr. Wagner will pursue training in 1) user centered design, an innovative implementation strategy, 2) conduct of pragmatic trials in diverse settings, and 3) assessment of the built and social environment and its effect on reach and implementation. This mentored research project and career development plan are designed to prepare Dr. Wagner to become a leader in the adaptation of effective interventions addressing substance use to better reach underserved populations and to produce sustainable implementation models.