Assessing the effects of hurricane Maria on Opioid Agonist Treatment access among PWID in rural Puerto Rico

评估飓风玛丽亚对波多黎各农村地区吸毒者获得阿片类药物激动剂治疗的影响

• 批准号: 9788395
• 负责人: Roberto Abadie
• 金额: $ 15.35万
• 依托单位: UNIVERSITY OF NEBRASKA LINCOLN
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9788395
• 关键词: Adherence; Affect; Alcohol or Other Drugs use; Area; Attention; Behavioral; Clinic; Collaborations; Communities; Community Practice; Data; Data Analyses; Data Collection; Development; Disasters; Drug usage; Drug user; Electricity; Enrollment; Epidemiology; Ethnography; Event; Follow-Up Studies; Food; Future; Grant; HIV; HIV/HCV; Harm Reduction; Health Insurance; Health Services; Health Services Accessibility; Hepatitis C Transmission; Homelessness; Hospitals; Hurricane; Individual; Infrastructure; Injecting drug user; Injections; Interruption; Intervention; Interview; Island; Knowledge; Medical; Mental Health; Methods; Modeling; Montana; Morbidity - disease rate; Motivation; National Institute of Drug Abuse; Natural Disasters; Needle-Exchange Programs; Network-based; Opiate Addiction; Outcome; Overdose; Participant; Pattern; Pharmaceutical Preparations; Pharmacotherapy; Policies; Population; Prevention; Public Health; Puerto Rico; Reporting; Research; Respondent; Risk; Risk Behaviors; Rural; Rural Community; Rural Population; Sampling; Source; Structure; Surveys; System; Time; Treatment outcome; United States National Institutes of Health; Weather; addiction; barrier to care; behavioral outcome; cohort; comparative; coping; cost; cost effective; disease transmission; drug distribution; drug market; epidemiologic data; ethnographic method; evidence base; experience; improved; injection drug use; innovation; mortality; opioid agonist therapy; overdose death; prevent; recruit; response; rural area; rural setting; social; tool; treatment adherence; treatment services

ABSTRACT In September 2017, hurricane Maria devastated Puerto Rico's physical and medical infrastructure. The effects of these events on drug-use related morbidity and mortality will be large. Opioid Agonist Treatment (OAT) has proven to be effective in lowering HIV/HCV transmission while also reducing overdose episodes, yet the influence of natural disasters on enrollment and adherence among people who inject drugs (PWID) is not well known. This R21 project allows for a post-disaster data collection with rural PWID living in four rural communities in Puerto Rico to document behavioral and structural factors affecting barriers and facilitators to OAT enrollment. In addition, this project will also describe participants' experiences coping with the aftermath of hurricane Maria and its impact on their ability or motivation to participate in OAT. Hurricanes and other natural disasters might create and/or reinforce existing barriers to OAT access and adherence. It is critical to understand this previously unexamined aspect of OAT participation and access among PWID in order to develop cost-effective strategies, limit barriers, and improve OAT retention using innovative models that incorporate the most recent developments in epidemiology, prevention, and treatment. Understanding the individual and structural obstacles to OAT participation after a natural disaster, will contribute to evidence based policies to improve future OAT access in disaster-impacted areas. This study will build upon considerable pre-hurricane data collection in the region as part of the Injection Risk Networks in Rural Puerto Rico project (R01DA037117). Prior findings from 356 active PWID in rural PR conducted between 2015-2017 (finished a few months before Maria struck) suggests that while most respondents participated at some point in OAT, only one in three had participated during the last year and one in six tried to enroll but faced barriers that prevented their enrollment. The data collection proposed here will allow for demographic, epidemiological, and mental health comparisons from before and after hurricane Maria, derived from a cohort of drug users in rural Puerto Rico living in Cidra, Comerio, Cayey and Aguas Buenas. In addition, we will conduct 40 ethnographic “treatment trajectory” narratives with a sub-sample of the PWID enrolled in the study. These interviews will collect narratives that focus on the lives and needs of participants as they move in and out of OAT treatment. These methods will help document cultural and structural determinants of addiction treatment and will provide additional evidence of the effects of hurricane Maria on OAT access. The current project will also allow our team to create an integrated knowledge exchange with a Community Advisory Board, whose understanding of the situation on the ground in Puerto Rico is likely to reflect post-disaster ideas about the current system of medically assisted treatment for opiate addiction on the Island. Post-disaster data collection on treatment access, adherence, and outcomes has the potential to significantly enhance our overall research capacity in rural areas and provide state and federal agencies with important knowledge to plan for and respond to future disasters.

摘要 2017年9月，飓风玛丽亚摧毁了波多黎各的物质和医疗基础设施。的影响 在这些事件中，与吸毒有关的发病率和死亡率将很高。阿片激动剂治疗（OAT） 已被证明可有效降低HIV/HCV传播，同时也可减少过量用药事件，但 自然灾害对注射吸毒者（PWID）的入组和依从性的影响不明显 知道的该R21项目允许对居住在四个农村社区的农村残疾人进行灾后数据收集 在波多黎各，记录影响OAT登记的障碍和促进因素的行为和结构因素。 此外，本项目还将描述参与者应对飓风玛丽亚后果的经历 及其对他们参与审裁处的能力或动机的影响。飓风和其他自然灾害可能 建立和/或加强现有的障碍，以获得和遵守OAT。在此之前理解这一点至关重要 为了制定具有成本效益的战略， 限制障碍，并使用结合最新发展的创新模式提高OAT保留率 流行病学，预防和治疗。了解OAT的个人和结构性障碍 在自然灾害后的参与，将有助于以证据为基础的政策，以改善未来的OAT获得， 受灾地区。这项研究将建立在该地区大量飓风前数据收集的基础上， 波多黎各农村注射风险网络项目（R 01 DA 037117）的一部分。来自356名活跃人员的既往发现 2015年至2017年进行的农村公共关系PWID（在玛丽亚袭击前几个月完成）表明， 大多数受访者在某个时候参加过OAT，只有三分之一的人在过去一年参加过， 六分之一的人试图入学，但面临阻碍他们入学的障碍。这里提出的数据收集将 考虑到玛丽亚飓风前后的人口、流行病学和心理健康比较， 来源于居住在西德拉、科梅里奥、卡伊和阿瓜斯卡拉斯的波多黎各农村吸毒者队列。在 此外，我们还将对40个民族志“治疗轨迹”进行叙述，并将PWID作为子样本 参加了这项研究。这些访谈将收集关注参与者生活和需求的叙述， 他们接受过OAT治疗这些方法将有助于记录文化和结构的决定因素 此外，还将提供更多证据，说明飓风玛丽亚对获得OAT的影响。的 目前的项目还将允许我们的团队创建一个与社区咨询的综合知识交流 该委员会对波多黎各当地局势的了解很可能反映了灾后的想法 关于目前岛上阿片类药物成瘾的医疗辅助治疗系统。灾后数据 收集治疗的可及性、依从性和结果有可能显著提高我们的整体水平。 农村地区的研究能力，并为州和联邦机构提供重要的知识， 应对未来的灾难。