Implementing a Community-Based Response to the Opioid Epidemic in Rural Ohio

对俄亥俄州农村地区的阿片类药物流行病实施基于社区的应对措施

• 批准号: 10242014
• 负责人: VIVIAN F. GO
• 金额: $ 84.72万
• 依托单位: OHIO STATE UNIVERSITY
• 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 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10242014
• 关键词: Abnormal coordination; Acute Hepatitis C; Address; Adoption; Advocacy; Affect; Behavior; Birth; Caring; Cessation of life; Characteristics; Collaborations; Communities; Consensus; Cost Savings; Country; County; Data; Death Rate; Decision Making; Drug Addiction; Epidemic; Epidemiology; Evidence based intervention; Funding; Geography; HIV; Health; Health Personnel; Health Services; Health Services Accessibility; Healthcare; Hepatitis B Virus; Hepatitis C; Hepatitis C virus; Heroin; Human Resources; Human immunodeficiency virus test; Immunization; Injecting drug user; Injections; Intervention; Interview; Law Enforcement; Laws; Legal; Maps; Methods; Modeling; Monitor; Morbidity - disease rate; Naloxone; Needle-Exchange Programs; Needs Assessment; Neonatal Abstinence Syndrome; Ohio; Opiate Addiction; Opioid; Outcome; Overdose; Patterns of Care; Penetration; Persons; Pharmaceutical Preparations; Phase; Pike fish; Policies; Politics; Powder dose form; Preparation; Prevalence; Process; Provider; Public Sector; Regulation; Resources; Respondent; Risk Behaviors; Rural; Rural Appalachia; Sampling; Service delivery model; Service provision; Services; Sexually Transmitted Diseases; Social Characteristics; Social Network; Surveys; Tars; Techniques; Telemedicine; Testing; Time; Training; Work; base; comorbidity; cost; cost efficient; data exploration; data format; design; experience; implementation outcomes; implementation strategy; improved; infectious disease treatment; injection drug use; medication-assisted treatment; multiple data sources; opioid abuse; opioid epidemic; opioid injection; opioid overdose; opioid use; overdose death; pill; prevent; program costs; programs; public health relevance; recruit; response; rural America; rural Americans; rural area; rural counties; scale up; screening; service coordination; service delivery; service gap; service programs; service providers; social culture; substance use; substance use treatment; surveillance data; tool; trafficking

PROJECT SUMMARY/ABSTRACT Ohio is experiencing one of the worst opioid injection epidemics in the country. The epidemic has severely affected rural Appalachian counties in southern Ohio, leading to a surge in overdose fatalities. Ohio’s heroin- related overdose rate is five times the national rate. In addition to overdose deaths, HCV has increased 400% between 2009-2013 and neonatal abstinence syndrome (NAS) has increased 9-fold between 2004-2014. Many evidence-based interventions (EBI), such as syringe service programs, medication-assisted treatment for substance use, naloxone provision for overdose treatment, and testing for HCV, HIV and sexually transmitted diseases (STD) are known to be effective in combating injection drug addiction and its consequences. Unfortunately, little is known about how to apply lessons learned in urban injection drug epidemics to sparsely- populated rural areas. In rural Ohio, as in much of the U.S., the delivery of EBI is limited or fragmented. A lack of coordination between key agencies to address overlap and gaps in services, especially in the context of severely constrained resources, has dire consequences for those struggling with opioid injection drug use. The proposed study will develop and implement a service delivery plan for EBI that can be scaled up in rural Ohio as well as other rural areas in the US experiencing opioid epidemics. In the UG3 phase, we will use a mixed methods approach to assess the socio-cultural and political context of the epidemic across multiple levels, including agencies, health care and service providers, and people who inject drugs (PWID) within three counties in rural Appalachia. We will use respondent-driven sampling (RDS) to assess injection behaviors and HCV, HIV, and STD prevalence. Building on this multi-level formative data, we will identify service gaps and work closely with key community stakeholders to build consensus around and prioritize the most relevant, feasible and acceptable implementation strategies to deliver EBI that may include coalition building, data synthesis across counties, crowdfunding models, and telemedicine. In the UH3 phase, we will implement, monitor and evaluate our service delivery plan for opioid injectors, using a regression point displacement design and repeat RDS surveys. Outcomes will include overdose deaths, NAS cases, HCV and HIV tests performed, and referral for HCV and HIV care. Implementation outcomes will include acceptability, adoption, feasibility, fidelity, penetration, sustainability, and cost. Scalability will be assessed by applying lessons learned in the UG3 phase in three additional counties during the UH3. Upon completion of the study, we will have enhanced EBI service delivery in multiple counties in Ohio and developed an exportable model of service needs assessment, community-engaged decision-making, and implementation. This model will be suitable for use throughout rural American in settings where opioid addiction has been identified and existing service delivery is limited or fragmented.

项目概要/摘要 俄亥俄州正在经历该国最严重的阿片类药物注射流行病之一。疫情已经严重 影响了俄亥俄州南部阿巴拉契亚乡村县，导致服药过量死亡人数激增。俄亥俄州的海洛因—— 相关药物过量发生率是全国的五倍。除了服药过量死亡外，HCV 增加了 400% 2009-2013年间，新生儿戒断综合症（NAS）在2004-2014年间增加了9倍。许多 基于证据的干预措施 (EBI)，例如注射器服务计划、药物辅助治疗 物质使用、纳洛酮过量治疗以及 HCV、HIV 和性传播疾病检测 众所周知，疾病（STD）可以有效对抗注射吸毒成瘾及其后果。 不幸的是，人们对如何将城市注射毒品流行中的经验教训应用到稀疏的地方知之甚少。 人口稠密的农村地区。与美国大部分地区一样，在俄亥俄州农村地区，EBI 的实施有限或分散。缺乏 关键机构之间的协调，以解决服务重叠和差距问题，特别是在 资源严重受限，给那些与阿片类注射毒品斗争的人们带来了可怕的后果。 拟议的研究将制定并实施一项 EBI 服务提供计划，该计划可以在 俄亥俄州农村地区以及美国其他农村地区正在经历阿片类药物流行病。在UG3阶段，我们将使用 采用混合方法评估流行病的社会文化和政治背景 级别，包括三级以内的机构、医疗保健和服务提供者以及注射吸毒者 (PWID) 阿巴拉契亚农村地区的县。我们将使用受访者驱动抽样 (RDS) 来评估注射行为和 HCV、HIV 和 STD 患病率。基于这些多层次的形成性数据，我们将确定服务差距并 与主要社区利益相关者密切合作，围绕最相关的问题建立共识并优先考虑 提供 EBI 的可行且可接受的实施策略，可能包括联盟建设、数据 跨县综合、众筹模式和远程医疗。在UH3阶段，我们将实施， 使用回归点位移来监控和评估我们的阿片类药物注射器服务交付计划 设计并重复 RDS 调查。结果将包括用药过量死亡、NAS 病例、HCV 和 HIV 检测 进行，并转介接受 HCV 和 HIV 护理。实施结果将包括可接受性、采用、 可行性、保真度、渗透力、可持续性和成本。将通过应用经验教训来评估可扩展性 UH3 期间另外三个县也处于 UG3 阶段。 研究完成后，我们将加强俄亥俄州多个县的 EBI 服务交付 开发了服务需求评估、社区参与决策的可输出模型，以及 执行。该模型将适合在美国农村地区使用阿片类药物的地区使用 已发现成瘾现象，现有的服务提供有限或支离破碎。