Ending transmission of HIV, HCV, and STDs and overdose in rural communities of people who inject drugs (ETHIC)

摘要 在中西部农村地区爆发的艾滋病毒和丙型肝炎病毒与共用注射器有关 注射非医疗处方阿片类药物的伴侣。伊利诺伊州是百分比第三高的州 2014-2015年间，涉及合成鸦片类药物的死亡率上升。最南端的16个县 伊利诺伊州包括伊利诺伊州三角洲地区(IDR)，并分享了农村地区的许多特征 经历了最近的艾滋病毒流行。更深入地了解社区特征，包括过渡 从口服到注射使用阿片类药物，高风险注射做法的情况，以及现有和 潜在的与卫生有关的资源将是发展疾病预防和治疗模式的关键。 与州和地方公共卫生其他州机构、基于社区的项目、地方联盟合作 和医疗系统，我们将采用混合分析方法，使用预测建模、地理信息系统分析、 定性和调查分析、网络方法和传染病流行病学的理解 地理空间和社会文化因素影响IDR注射吸毒者的健康结果。这些 数据将为循证干预措施提供信息，以加强疾病筛查和与护理的联系 和治疗，扩大针具交换和纳洛酮过量方案，筛查和转诊 物质使用治疗和远程保健能力建设，以提供PrEP、丙型肝炎病毒管理和 药物辅助治疗药物使用障碍。 UG3目标1.确定伊利诺伊州三角洲农村地区阿片类药物滥用风险最大的地理区域 以及基于疾病监测、医疗保健利用、处方药的IDR传染病 监测、逮捕和缉获毒品以及绘制资源稀缺性地图。 UG3目标2.了解社会文化因素如何影响风险和健康寻求行为、社会网络、 以及在目标1中确定的高危地理区域注射毒品者的疾病传播。 UG3目标3.综合和应用流行病学、地理空间、定性和网络数据以提供信息 扩大减少伤害服务和有针对性的远程保健能力建设，以提供相关的临床护理。 UH3目标1.扩大减少伤害服务，包括注射器服务、纳洛酮过量预防、 药物使用治疗转介、艾滋病毒、丙型肝炎病毒、乙肝病毒和性传播疾病检测以及通过能力与护理的联系 建立现有的方案，以及通过新的当地卫生部门的减少伤害单位。 UH3目标2.建设丙型肝炎病毒管理、PrEP、药物使用筛查、转诊和药物治疗的能力- 通过针对PWID首选设置的远程保健计划进行辅助治疗。 UH3目标3.根据CDC RE-AIM框架评估计划执行情况，继续参与 利益攸关方，州和地方一级服务的整合和协调，以及资金的可持续性。

ABSTRACT Outbreaks of HIV and HCV in rural areas of the Midwest have been associated with syringe-sharing among partners injecting nonmedical prescription opioids. Illinois ranks as the third highest state in percentage increase in death rates involving synthetic opiates between 2014-2015. The southernmost 16 counties of Illinois comprise the Illinois Delta Region (IDR) and share many of the characteristics of rural areas that have experienced recent HIV epidemics. A deeper understanding of community characteristics, including transitions from oral to injection opioid use, circumstances for high-risk injection practices, and accessibility to existing and potential health-related resources will be essential to developing models of disease prevention and treatment. Partnering with state and local public health other state agencies, community based programs, local coalitions and healthcare systems, we will take a mixed analytical approach using predictive modeling, GIS analysis, qualitative and survey analysis, network methods, and infectious disease epidemiology to understand geospatial and sociocultural factors impacting health outcomes in people who inject drugs in the IDR. These data will inform evidence-based interventions to strengthen access to disease screening and linkage to care and treatment, expansion of needle exchange and naloxone overdose programs, screening and referral to substance use treatment, and telehealth capacity building for the provision of PrEP, HCV management, and medication-assisted treatment for substance use disorder. UG3 Aim 1. Determine the geographic areas in the rural Illinois Delta Region at greatest risk for opioid misuse and infectious diseases in the IDR based on disease surveillance, healthcare utilization, prescription drug monitoring, arrest and drug seizure, and resource scarcity mapping. UG3 Aim 2. Understand how sociocultural factors impact risk and health seeking behaviors, social networks, and disease transmission of people who inject drugs in high risk geographic areas identified in Aim 1. UG3 Aim 3. Integrate and apply the epidemiological, geospatial, qualitative and network data to inform expanded harm-reduction services and targeted telehealth capacity building for related clinical care. UH3 Aim 1. Expand harm reduction services including syringe services, naloxone overdose prevention, substance use treatment referral, HIV, HCV, HBV and STDs testing and linkage to care through capacity building of existing programs as well as through new local health department based harm reduction units. UH3 Aim 2. Build capacity for HCV management, PrEP, substance use screening, referral, and medication- assisted treatment through telehealth programs targeted at PWID-preferred settings. UH3 Aim 3. Evaluate program implementation based on CDC RE-AIM framework, continued engagement of stakeholders, integration and coordination of services at the state and local level, and sustainability of funding.