Assessing Care in the Context of an HIV Outbreak among PWID in Appalachia

获奖作品摘要 本更新申请（R 01 DA 033862）的总体目标是确定结构性 在阿巴拉契亚农村吸毒者中开展减少风险和促进健康活动的干预措施 用户.研究人员试图继续进行的为期三年的R 01研究结果显示， 滥用处方药的情况;一种仍处于婴儿期的流行病不像许多农村和郊区 在这些地区，几乎没有证据表明过渡到海洛因滥用。在这群人中， 从滥用奥施康定®（缓释羟考酮）到速释羟考酮， 含有丁丙诺啡和加巴喷丁的产品。此外，HCV的患病率和发病率是 特别是考虑到阿巴拉契亚农村的人口密度。鉴于阿片类药物滥用的流行病学， 传染病传播，两种结构性干预措施对农村人口特别重要。 吸毒者（PWUD）医疗补助（MC）扩展（根据平价医疗法案[ACA]）和注射器 接入计划（SAP）是两种结构性干预措施，可以增加卫生参与 促进PWUD，但很可能受到个人，网络和社区层面的因素。 利用拉特金的动态社会系统模型，并利用现存的，非常成功的农村队列 PWUD的目标包括：1）检查这些结构性干预措施的动态因素如何影响 非法药物和处方药滥用的纵向趋势; 2）确定这些结构性影响 艾滋病毒/丙型肝炎发病率和参与降低风险的干预措施; 3）评估这些措施的影响 对接受药物滥用治疗进行结构性干预。这项研究意义重大，因为 了解这些具体的结构性干预措施影响健康促进的机制， 改善阿巴拉契亚乡村公共卫生的关键。药物滥用和HCV是两个最重要的，如果 这一地区面临的最重要的健康问题并不是已经受到明显健康差距的困扰。使用 网络和地理空间风险的创新措施，以及联合分析和多层次纵向 统计模型，结果不仅将为制定优化吸收和利用的干预措施提供信息， 风险降低服务，如SAP和药物滥用治疗，但可能会告知周围的政策 在美国农村地区进一步实施健康促进计划。

ABSTRACT FROM PARENT AWARD The overarching goal of this renewal application (R01DA033862) is to determine the influence of structural interventions on engagement in risk reduction and health promotion activities among rural Appalachian drug users. Results from the three-year R01 that the investigators seek to continue reveal an ever-changing landscape of prescription drug abuse; an epidemic that is still in its infancy. Unlike many rural and suburban areas, there is little evidence for the transition to heroin abuse. In this cohort, there has been a marked shift from abuse of OxyContin® (extended-release oxycodone) to immediate release oxycodone to more recently, buprenorphine and gabapentin-containing products. In addition, rates of HCV prevalence and incidence are high, especially given the population density of rural Appalachia. Given the syndemic of opioid abuse and infectious disease transmission, two structural interventions are particularly relevant to this population of rural people who use drugs (PWUD). Medicaid (MC) expansion (under the Affordable Care Act [ACA]) and syringe access programs (SAP) are two structural interventions that may allow for increased engagement in health promotion among PWUD, but are likely heavily influenced by individual, network, and community-level factors. Utilizing Latkin’s Dynamic Social Systems model and leveraging the extant, highly successful cohort of rural PWUD, the aims include: 1) examining how dynamic factors of these structural interventions influence longitudinal trends in illicit and prescription drug abuse; 2) determining the influence of these structural interventions on HIV/HCV incidence and engagement in risk reduction; and 3) assessing the influence of these structural interventions on uptake of substance abuse treatment. This study is highly significant given that understanding the mechanisms by which these specific structural interventions influence health promotion is key to improving public health in rural Appalachia. Substance abuse and HCV are two of the most important, if not the most important health issues facing this region already plagued with marked health disparities. Using innovative measures of network and geospatial risk, as well as conjoint analysis and multilevel longitudinal statistical models, results will not only inform development of interventions that optimize uptake and utilization of risk reduction services such as SAP and substance abuse treatment, but may inform policies surrounding further implementation of health promotion programs in the rural U.S.