Expansion of Mail-Delivered Harm Reduction Services in the U.S.

扩大美国邮件递送减害服务

• 批准号: 10590378
• 负责人: Czarina Navos Behrends
• 金额: $ 239.34万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2025-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10590378
• 关键词: AIDS prevention; Acute; Address; Area; Black race; Blood; COVID-19; Client; Cohort Studies; Development; Disease; Disease Outbreaks; District of Columbia; Drug usage; Environment; Face; Fentanyl; Fright; Future; HIV/HCV; Harm Reduction; Health; Health Services; Hispanic; Home; Hour; Injecting drug user; Injections; Intervention; Interview; Investigation; Law Enforcement; Laws; Legal; Longitudinal cohort study; Modality; Naloxone; Needle-Exchange Programs; Online Systems; Overdose reversal; Participant; Perception; Persons; Pharmacy facility; Policies; Population; Public Health; Reporting; Risk; Risk Behaviors; Route; Rural; Sample Size; Secure; Services; Source; Surveys; Syringes; Taxonomy; Technology; Time; Transportation; Underserved Population; Woman; Youth; acceptability and feasibility; base; design; experimental study; follow-up; gaps in access; health care delivery; high risk; housing instability; improved; innovation; insight; meetings; opioid overdose; opioid use; overdose death; peer; preference; prevent; programs; recruit; scale up; secondary analysis; service delivery; service engagement; social media; social stigma; test strip; uptake

PROJECT SUMMARY COVID-19 has led to record high overdose deaths in the US and high risk for future injection-related HIV and hepatitis c (HCV) outbreaks. Innovative approaches are urgently needed to expand access to syringes and naloxone, a drug used for opioid overdose reversal, for the prevention of HIV/HCV outbreaks and opioid overdose fatalities. Expansion and scale-up of mail-based harm reduction services may address harm reduction access gaps by providing a more convenient and confidential way to obtain services. To inform scale-up these services, we aim to 1) describe policy barriers to national expansion of mail-based syringe services and fentanyl strip distribution, 2) conduct a national, longitudinal cohort study to examine predictors of uptake and long-term engagement in mail-based harm reduction services, and 3) assess the add-on harm reduction and health services preferences of mail delivery clients. For Aim 1, we will conduct a systematic legal review of relevant laws in each of the 50 states and the District of Columbia to determine whether and how state law may impact the legality of distributing syringes and fentanyl test strips by mail. We will develop a taxonomy of policies that may prevent legal expansion of mail-delivered syringes. To understand the perception of legal risks associated with mailing syringes among potential adopters, we will survey and interview 20 stakeholders (i.e., health departments and SSPs) from states representing different legal environments for mail-delivery. For Aim 2, we will build on a social media-recruited survey examining uptake and acceptability of mail-delivered harm reduction by expanding the follow up period of that survey from 6 months to 12 and 18 months and expanding the sample size of this survey. This will allow us to assess predictors of uptake and mail-delivered harm reduction engagement over the long-term in order to fully understand who uses mail-delivered services and how these services are being used over time. For Aim 3 we will design and implement discrete choice experiment (DCE) surveys to determine mail-based service client preferences for receiving add-on harm reduction and health services. These results will be disseminated to policy stakeholders, potential adopters, and NEXT affiliates to inform expansion and scale-up of mail-based harm reduction services, improve engagement with current NEXT users, and expand the type of services offered through these programs.

项目摘要 COVID-19已导致美国创纪录的过量死亡人数，以及未来与注射相关的艾滋病毒的高风险， 丙型肝炎（HCV）爆发。迫切需要采取创新办法，扩大获得注射器的机会， 纳洛酮，一种用于阿片类药物过量逆转的药物，用于预防HIV/HCV爆发和阿片类药物 吸毒过量致死扩展和扩大基于邮件的减少危害服务可以解决危害 通过提供更方便和保密的方式获得服务，缩小获得服务的差距。通知 为了扩大这些服务，我们的目标是1）描述国家扩大邮寄注射器的政策障碍 服务和芬太尼条分布，2）进行一项全国性的纵向队列研究，以检查 接受和长期参与基于邮件的减少伤害服务，以及3）评估附加伤害 减少和健康服务的邮件交付客户的偏好。为了实现目标1，我们将进行系统的法律的 审查50个州和哥伦比亚特区的相关法律，以确定是否以及如何 州法律可能会影响通过邮件分发注射器和芬太尼测试条的合法性。我们将开发一个 可能阻止邮寄注射器的法律的扩展的政策分类。了解 对潜在采用者中与邮寄注射器相关的法律的风险的看法，我们将调查， 与20个利益攸关方进行访谈（即，代表不同法律的州的卫生部门和SSP 邮件递送的环境。对于目标2，我们将在社交媒体招募调查的基础上， 通过将该调查的随访期从6个月延长到6个月， 将调查时间延长至12个月和18个月，并扩大本次调查的样本量。这将使我们能够评估 长期采用和邮寄减少危害的预测因素，以便充分 了解谁使用邮件传递服务，以及这些服务在一段时间内如何使用。对于目标3， 将设计和实施离散选择实验（DCE）调查，以确定基于邮件的服务客户 优先接受附加的减少危害和保健服务。这些结果将分发给 政策利益相关者，潜在的采用者和NEXT附属机构，以告知扩展和扩大基于邮件的 减少伤害服务，改善与当前NEXT用户的接触，并扩大服务类型 通过这些方案。