Rapid measurement of novel harm reduction housing on HIV risk, treatment uptake, drug use and supply

快速测量新型减害住房对艾滋病毒风险、治疗接受情况、毒品使用和供应的影响

• 批准号: 10701309
• 负责人: TRACI C GREEN
• 金额: $ 26.33万
• 依托单位: BRANDEIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10701309
• 关键词: Abstinence; Acute Hepatitis; Address; Affect; Air; Area; Behavior; Boston; COVID-19 pandemic; Caring; Catalogs; Cause of Death; Cities; Communicable Diseases; Communities; Contracts; Crime; Data; Data Set; Disasters; Disease Outbreaks; Drug abuse; Drug usage; Enrollment; Environment; Epidemiology; Equipment and supply inventories; Evolution; Exposure to; Fentanyl; Gender; Goals; HIV; HIV risk; Harm Reduction; Health; Hepatitis A Virus; Homeless persons; Homelessness; Hospitals; Housing; Illicit Drugs; Improve Access; Individual; Infection; Injections; Intervention; Interview; Leadership; Learning; Life; Link; Massachusetts; Measurement; Measures; Methods; Naloxone; Natural experiment; Outcome; Overdose; Patterns of Care; Persons; Pharmaceutical Preparations; Policies; Positioning Attribute; Process; Prophylactic treatment; Public Health; Public Housing; Research; Research Support; Risk; Risk Behaviors; Role; SARS-CoV-2 infection; Safety; Science; Seasons; Service provision; Services; Site; Social isolation; Social outcome; Sterility; Structure; Surveys; Syringes; Time; United States; Violence; Work; addiction; cohort; coronavirus disease; drug market; experience; health care service; improved outcome; insight; meetings; member; multidisciplinary; novel; overdose risk; peer; peer support; pre-exposure prophylaxis; prevention service; programs; public health emergency; residence; response; risk mitigation; service uptake; social; social cohesion; social health determinants; statistics; success; supported housing; syndemic; transitional housing; uptake

The COVID-19 pandemic has strained an ongoing housing crisis across cities and towns, leaving unprecedented numbers of people homeless and creating poor health conditions in precarious, concentrated homeless encampments. In Boston, Massachusetts, an October 2021 public health emergency declaration preceded a January 2022 massive relocation campaign that moved over 200 people from a large street encampment into 5 novel “harm reduction housing” (HRH) programs. The area is known for its proximity to area hospitals, its open-air drug market, and violence related to drugs and crime. These programs provide housing units with access to harm reduction supplies like sterile syringes and other safer use materials, naloxone, and low-barrier medication treatment, and staff provide these services according to policies that champion the principles of “meeting people where they are”. But the HRH sites differ in ways that may affect resident outcomes, and uptake of services vary. Data suggest that housing interventions may tragically increase isolation and thus overdose risk; others claim lives will be saved and life-saving treatments will start because of their improved access at the HRH sites. An initial case-crossover analysis of those recently relocated echoed a mixture of positive and negative effects. Lacking clear-cut, scientifically rigorous processes that consider both intended and unintended consequences of these actions, we propose a rapid, mixed methods study to efficiently examine the immediate effects of the relocation efforts and the longer-term impacts of living in the novel HRH. Specifically, this time-sensitive study will collect survey, interview, and drug supply data from the community of people who are homeless and use drugs in the concentrated area of Boston who have been affected by these recent actions. The study will help to determine short and long-term impacts of: a) rapid relocation and how residents successfully navigated it; and b) co-provision of harm reduction services and housing on individual- level behaviors and local drug supply outcomes. Specific aims are to: Aim 1) Develop a measure of harm reduction services and policies to inventory their provision and use in HRH sites for studying continuity, uptake, and evolution of care. Aim 2) Enroll an observational cohort following 100 HRH residents for 12 months to catalogue relocation effects and understand how harm reduction services use changes drug use, HIV and drug risk behaviors, treatment uptake, and the local drug supply. Data specific to new HRH resident cohort members will augment our prior case-crossover analysis of relocation impacts. Aim 3) Conduct repeat, longitudinal one-on-one interviews with 25 cohort members to gain greater insight into the nuances of relocation and HRH residence, including health and safety impacts, changes in collective efficacy, and gender considerations. Findings will contribute to harm reduction science and will be directly relevant to jurisdictions considering HRH, adapting housing contracts to incorporate harm reduction services, and planning public health-directed mitigation plans for housing relocations or disaster responses.

COVID-19大流行使城镇的住房危机持续紧张， 无家可归者人数增加，并在不稳定、集中的无家可归者中造成恶劣的卫生条件 营地在马萨诸塞州的波士顿，2021年10月的公共卫生紧急状态宣布之前， 2022年1月大规模搬迁运动，将200多人从一个大型街道营地转移到5个 新的“减少危害住房”计划。该地区以靠近地区医院而闻名， 露天毒品市场以及与毒品和犯罪有关的暴力。这些方案为住房单位提供 获得减少伤害的用品，如无菌注射器和其他更安全的使用材料，纳洛酮和低屏障 药物治疗，工作人员提供这些服务，根据政策，冠军的原则， “在人们所在的地方与他们会面”。但是HRH站点在可能影响居民结果的方式上有所不同， 服务的使用情况各不相同。数据表明，住房干预可能会悲剧性地增加隔离， 过量的风险;其他人声称生命将被挽救，挽救生命的治疗将开始，因为他们的改善 进入HRH网站。对那些最近搬迁的人进行的初步病例交叉分析反映了以下几种情况的混合 积极和消极的影响。缺乏明确的，科学严谨的过程，认为这两个意图 和这些行动的意外后果，我们提出了一个快速，混合方法的研究，以有效地检查 搬迁工作的直接影响和生活在新的HRH的长期影响。 具体而言，这项时间紧迫的研究将收集社区的调查、访谈和药物供应数据 在波士顿的集中地区，无家可归和吸毒的人受到这些影响， 最近的行动。这项研究将有助于确定以下方面的短期和长期影响：a）迅速搬迁， 居民成功地驾驭了它;和B）共同提供减少危害的服务和住房的个人- 水平行为和当地药物供应结果。具体目标是：目标1）制定一个衡量损害的标准 减少服务和政策，以清点其在HRH站点的提供和使用情况，以研究连续性， 和护理的发展。目标2）招募一个观察队列，跟踪100名HRH居民，为期12年 几个月的时间来记录搬迁的影响，并了解减少伤害服务的使用如何改变药物使用，艾滋病毒 以及药物风险行为、治疗吸收和当地药物供应。新HRH住院医师队列的特定数据 成员将增加我们以前的案例交叉分析搬迁的影响。目的3）进行重复， 与25名队列成员进行纵向一对一访谈，以更深入地了解 搬迁和HRH居住，包括健康和安全影响，集体效能的变化，以及性别 注意事项。调查结果将有助于减少危害科学，并将直接与司法管辖区有关 考虑HRH，调整住房合同以纳入减少危害服务，并规划公共 以健康为导向的住房搬迁或救灾减灾计划。