Kentucky Communities & Researchers Engaging to Halt the Opioid Epidemic-CARE2HOPE

阿片类药物滥用和相关危害的发生中心（例如，HCV、过量、HIV）正从城市向农村蔓延 在美国的地区。这些地震般的流行病学变化是农村公共卫生系统尚未解决的危机。 农村地区与毒品有关的保健服务存在着广泛的“执行鸿沟”。肯塔基州- a 在这些与毒品有关的流行病的前沿，主要是农村国家-开始缩小这一鸿沟， 注射器服务计划（SSP）的空前扩张。2015年至2018年， 在肯塔基州经营的法律的服务提供商数量从0激增至40家。肯塔基州的扩张是一个更广泛的 阿巴拉契亚地区和其他农村地区的趋势。这种扩展代表了一种“横向扩展”， 与城市起源有质的不同的实施环境。农村地区可能会出现 SSP采用、忠诚度和持续性的障碍和促进因素的集合，与 城市例如，成本可能是农村地区采用、忠实和维持的一个更重要的障碍， 那里的预算更加有限。SSP人员可能会产生新的方法来实现核心组件 适合农村情况，SSP对客户风险行为和服务使用的影响也可能不同 在农村地区（例如，运输障碍和当地服务的缺乏可能会限制成功的联系， 其他服务）。值得注意的是，很少有研究探索这些可能性：最近的Medline搜索使用变体 术语“SSP”、“农村”和“实施科学”中没有发现文章。这项拟议的研究是第一次 建立下一代实施科学的一步，以提高其有效性， 新一轮农村小微企业。在实施研究综合框架的指导下，我们将使用 定性，多个案例研究设计，研究最近在7个农村肯塔基州县开设的SSP，以（1） 查明在农村执行工作中采用和维持小规模战略项目的障碍和促进因素， 并探索克服采用和维持障碍的战略。(2)分析一下 SSP忠实于既定的核心组件;确定新兴的新方法来实施核心组件 这些SSP可能已经创新的组件;并检查通过选择，突出 执行环境的特点可能影响了这种忠实性和创新性。(3)探索PWID 对SSP核心成分是否以及如何影响HIV、HCV和过量风险行为的看法， SSP客户和其他本地PWID中与药物相关的健康服务使用情况。这是对 “CARE2HOPE”（DA044798）。在杨博士和库珀博士的领导下，CARE 2 HOPE旨在建立证据- 基于干预措施（EBI）的阿片类药物滥用流行病和相关危害在12个农村肯塔基州县， 这些相互交织的国家危机的中心。几个CARE 2 HOPE县正在考虑加强 SSPs作为其EBI的一部分。该补充将有助于确定SSP忠诚度或维持的障碍， 可以解决。它还将产生一个高影响力的农村SSP实施科学的新路线的假设。

Epicenters of opioid misuse and related harms (e.g., HCV, overdose, HIV) are expanding from cities to rural areas in the US. These seismic epidemiologic shifts are crises that rural public health systems have yet to meet, and a wide “implementation chasm” exists for drug-related health services in rural areas. Kentucky – a predominately rural state at the forefront of these drug-related epidemics – is starting to close this chasm by mounting an unprecedented expansion of syringe service programs (SSPs). Between 2015 and 2018, the number of legal SSPs operating in Kentucky surged from 0 to 40. This Kentucky expansion is part of a broader trend in the Appalachian region and other rural areas. This expansion represents a “scale out” that takes SSPs to implementation contexts that differ qualitatively from their urban origins. Rural areas may present a constellation of barriers and facilitators to SSP adoption, fidelity, and sustainment that differ from those in cities. Cost, for example, may be a more significant barrier to adoption, fidelity, and sustainment in rural areas, where budgets are far more constrained. SSP staff may generate novel ways to implement core components that suit rural contexts, and SSP impact on risk behaviors and service use among clients may also be different in rural areas (e.g., transportation barriers and the paucity of local services may limit successful linkage to other services). Notably, little research has explored these possibilities: a recent Medline search using variants of the terms “SSP,” “rural,” and “implementation science” identified no articles. The proposed study is a first step toward establishing the next generation of implementation science to enhance the effectiveness of this new wave of rural SSPs. Guided by the Consolidated Framework for Implementation Research, we will use a qualitative, multiple case study design to study SSPs that recently opened in 7 rural Kentucky counties to (1) Identify perceived barriers and facilitators in the rural implementation context to adopting and sustaining SSPs, and explore strategies to overcome barriers to adoption and sustainment. (2) Analyze the extent to which SSPs are faithful to established core components; identify emerging novel approaches to implementing core components that these SSPs may have innovated; and examine the processes through which select, salient features of the implementation context may have influenced this fidelity and innovation. (3) Explore PWID perceptions of whether and how SSP core components influence HIV, HCV, and overdose risk behaviors and drug-related health service use among SSP clients and other local PWID. This is a supplement to “CARE2HOPE” (DA044798). Led by Drs. Young and Cooper, CARE2HOPE is designed to build evidence- based interventions (EBIs) for epidemics of opioid misuse and related harms in 12 rural Kentucky counties at an epicenter of these intertwined national crises. Several CARE2HOPE counties are considering enhancing SSPs as part of their EBI. This supplement will help identify barriers to SSP fidelity or sustainment that they could address. It will also generate hypotheses for a new line of high-impact rural SSP implementation science.