Kentucky Communities and Researchers Engaging to Halt the Opioid Epidemic (CARE2HOPE)

肯塔基州社区和研究人员致力于制止阿片类药物的流行 (CARE2HOPE)

• 批准号: 10241254
• 负责人: Hannah LF Cooper
• 金额: $ 126.76万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-15 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10241254
• 关键词: Address; Appalachian Region; Area; Behavioral; Caring; Centers for Disease Control and Prevention (U.S.); Cities; Coal; Collaborations; Communities; Community Trial; Country; County; Disease Outbreaks; Drug user; Effectiveness; Elements; Ensure; Environment; Epidemic; Epidemiologic Methods; Epidemiology; Evidence based intervention; General Population; HIV; HIV/HCV; Harm Reduction; Health; Health Services; Hepatitis C virus; Heroin; Incidence; Infrastructure; Injecting drug user; Injections; Intervention; Kentucky; Knowledge; Laws; Letters; Methods; Modeling; Naloxone; National Institute of Drug Abuse; Needle-Exchange Programs; Outcome; Overdose; Pathway Analysis; Pharmaceutical Preparations; Phylogenetic Analysis; Plant Roots; Policies; Prescription opioid overdose; Provider; Public Health; Qualitative Research; Readiness; Research Infrastructure; Research Personnel; Resources; Risk; Risk Assessment; Rivers; Rural; Rural Appalachia; Services; Site; Substance Use Disorder; Testing; United States Substance Abuse and Mental Health Services Administration; Unsafe Sex; Work; base; combat; community based research; cost effectiveness; data exchange; design; evidence base; implementation science; improved; infectious disease treatment; injection drug use; innovation; intervention mapping; mathematical model; member; misuse of prescription only drugs; opioid epidemic; opioid injection; prescription opioid; randomized trial; response; rural counties; social stigma; theories; virtual

Abstract: The proposed project will build evidence-based, community-rooted public health responses to the epidemics of non-medical prescription opioid (NMPO) and heroin injecting, overdoses (ODs), and HCV, and to imminent HIV outbreaks, in 12 rural Appalachian Kentucky counties at the epicenter of these intertwined national crises. 10 counties rank in the top 5% for HIV/HCV vulnerability. Rates of HCV, injection drug use (IDU), and ODs are high in these counties, and most are in coal country, an RFA priority. Unfortunately, these counties exemplify an extreme version of the “implementation chasm,” a chasm dividing scientific knowledge from action. Evidence-based public health responses to these epidemics exist (e.g., syringe service programs [SSPs]) and are often deployed in cities. In these 12 rural counties, though, scarcities of resources and of providers conspire with drug-related stigma to constrain public health responses. The counties' public health infrastructures are weak, their harm reduction infrastructures virtually non-existent. This project will bridge the implementation chasm in these 12 counties, and recognizes that bridging this chasm requires more than simply importing SSPs and other evidence-based community response projects (EB-CRPs) from cities. Guided by harm reduction principles, the Risk Environment Model, and Community/ Academic Partnerships (CAPs), in the UG3 we will: (1) Assess and enhance each county's readiness to improve the local risk environment. (2) Examine the strengths, resources, needs, and gaps of each county's risk environment. We will conduct a multi-method Community Assessment of the Risk Environment that integrates innovative, rigorous epidemiology (e.g., modeling); policy assessment; and best practices in community-based research (e.g., CAPs). (3) Select a package of EB-CRPs that responds to local needs and strengths, using elements of Intervention Mapping. Go/no go milestone: Each CAP will have created an EB- CRP package that (1) addresses targets common across all counties (e.g., opioid injection, OD, HCV, HIV), and (2) is tailored to local needs, resources, and readiness. In the UH3, we will: (4) Tailor selected EB-CRPs to each county's context using ADAPT-ITT. (5) Analyze the effectiveness and cost-effectiveness of each county's EB-CRP package, using an innovative stepped-wedge community randomized trial and mathematical models. We will use continuous quality improvement to enhance each EB-CRP's fidelity, reach, immediate effects, and outcomes. To inform interventions, advanced network analyses will overlay risk networks with GHOST phylogenetic transmission data to show where HCV has been and predict where it is going. We draw strength from our collaborations. CAPs will meld residents' local knowledge with researchers' scientific expertise. Multi- PIs Young and Cooper have assembled an academic team with unsurpassed expertise in key substance, theories, and methods, and in multisite studies. The combination of a rigorous, innovative design (e.g., step- wedge community trials), strong theories, and a stellar team with community roots will ensure high impact.

摘要：拟议的项目将建立以证据为基础、以社区为基础的公共卫生应对措施 非医用处方阿片类药物(NMPO)和海洛因注射、过量(OD)和丙型肝炎病毒(丙型肝炎)的流行，以及 迫在眉睫的艾滋病毒暴发，在阿巴拉契亚肯塔基州12个农村县的震中这些交织在一起 国家危机。艾滋病毒/丙型肝炎病毒易感性排名前5%的县有10个。丙型肝炎病毒注射吸毒率 (IDU)，这些县的OD值很高，而且大多数都在煤炭国家，这是RFA的优先事项。 不幸的是，这些县是“执行鸿沟”的一个极端版本，一个鸿沟 把科学知识和行动分开。存在针对这些流行病的循证公共卫生对策 (例如，注射器服务计划[SSP])，并经常部署在城市中。然而，在这12个农村县， 资源和提供者的匮乏与与毒品有关的污名共同制约了公共卫生的反应。 这些县的公共卫生基础设施薄弱，其减少危害的基础设施几乎不存在。 该项目将在这12个县弥合执行鸿沟，并认识到弥合这一鸿沟 CHASM需要的不仅仅是简单地引入SSP和其他以证据为基础的社区应对项目 (EB-CRPS)来自城市。以减少危害原则、风险环境模型和社区/ 学术伙伴关系(CAPS)，在UG3中，我们将：(1)评估和加强每个国家的准备情况 改善地方风险环境。(2)检查各县的优势、资源、需求和差距 风险环境。我们将对风险环境进行多方法社区评估， 整合创新、严格的流行病学(例如，建模)、政策评估和最佳做法 基于社区的研究(例如，CAPS)。(3)选择符合当地需求的EB-CRPS套餐， 优势，使用干预地图的元素。通过/不通过里程碑：每个CAP将创建一个EB- CRP包，(1)涉及所有县的共同目标(例如，阿片注射、吸食过量、丙型肝炎、艾滋病毒)， 以及(2)根据当地需求、资源和准备情况量身定做。在UH3中，我们将：(4)裁剪选择EB-CRP 每个县的情况使用Adapt-ITT。(5)分析各县的效益和成本效益 EB-CRP包，采用创新的阶梯楔形社区随机试验和数学模型。 我们将通过持续的质量改进来提高每个EB-CRP的保真度、可达性、即时效果和 结果。为了向干预措施提供信息，高级网络分析将使用Ghost覆盖风险网络 系统进化传输数据，以显示丙型肝炎病毒的去向并预测其去向。我们汲取力量 来自我们的合作。CAPS将把居民的当地知识与研究人员的科学专业知识融合在一起。多个- PiS Young和Cooper组建了一支在关键内容上拥有无与伦比的专业知识的学术团队， 理论和方法，以及多地点研究。结合严谨、创新的设计(例如，STEP- 楔形社区试验)，强大的理论，以及一支扎根于社区的明星团队，将确保高影响力。

项目成果

Factors that influence enrollment in syringe services programs in rural areas: a qualitative study among program clients in Appalachian Kentucky.

• DOI: 10.1186/s12954-021-00518-z
• 发表时间: 2021-06-30
• 期刊: Harm reduction journal
• 影响因子: 4.4
• 作者: Ibragimov U;Cooper KE;Batty E;Ballard AM;Fadanelli M;Gross SB;Klein EM;Lockard S;Young AM;Cooper HLF
• 通讯作者: Cooper HLF