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.

项目总结 新冠肺炎导致美国创纪录的过量死亡人数和未来与注射相关的艾滋病毒和 丙型肝炎(丙型肝炎)爆发。迫切需要创新的办法，以扩大获得注射器和 纳洛酮，一种用于阿片类药物过量逆转的药物，用于预防艾滋病毒/丙型肝炎暴发和阿片类药物 服药过量致死。扩大和扩大基于邮件的减害服务可能会解决危害问题 通过提供更方便、更保密的方式获得服务，缩小准入差距。通知 扩大这些服务，我们的目标是1)描述在全国范围内推广邮寄注射器的政策障碍 服务和芬太尼条带分布，2)进行全国性的纵向队列研究，以检查预测 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 邮件递送客户的减少和健康服务偏好。对于目标1，我们将进行系统的法律 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寄分发注射器和芬太尼试纸的合法性。我们将开发一种 可能阻止邮寄注射器合法扩张的政策的分类。要了解 潜在领养者对邮寄注射器相关法律风险的看法，我们将进行调查和 采访了来自代表不同法律的州的20个利益相关者(即卫生部门和SSP) 邮件递送的环境。对于目标2，我们将建立在社交媒体招募的调查基础上，以检查理解 以及邮递减少危害的可接受性，将该调查的跟踪期从6个扩大到 两个月至12个月和18个月，并扩大本次调查的样本规模。这将使我们能够评估 长期接触和邮寄减少伤害参与度的预测因素，以便充分 了解谁在使用邮件递送服务，以及随着时间的推移这些服务是如何被使用的。对于目标3，我们 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 对获得附加的减少伤害和健康服务的偏好。这些结果将传播给 政策利益相关者、潜在采用者和下一代分支机构，为基于邮件的扩展和纵向扩展提供信息 减少危害服务，提高与当前下一批用户的参与度，并扩展服务类型 通过这些计划提供。