Promoting remote harm reduction and secondary services in rural settings (PROMOTE) study

促进农村地区减少远程伤害和二级服务 (PROMOTE) 研究

• 批准号: 10590281
• 负责人: MARY ELLEN MACKESY-AMITI
• 金额: $ 240.57万
• 依托单位: UNIVERSITY OF CHICAGO
• 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/10590281
• 关键词: Address; Adopted; Anti-Anxiety Agents; Baseline Surveys; Behavior; Car Phone; Characteristics; Chronic; Client; Communities; Computer Models; County; Data; Decision Making; Diagnostic Reagent Kits; Disease Outbreaks; Drug usage; Drug user; Ecological momentary assessment; Evaluation; Fentanyl; Foundations; Frequencies; Future; HIV; HIV/HCV; Harm Reduction; Health; Hepatitis C; Hepatitis C Incidence; Illinois; Individual; Infection; Injections; Intervention; Interview; Knowledge; Link; Mail Order; Methamphetamine; Methamphetamine use disorder; Methods; Modeling; Morbidity - disease rate; Motivation; Naloxone; Needle-Exchange Programs; Needs Assessment; Opioid; Outcome; Participant; Persons; Pharmaceutical Preparations; Population; Prevalence; Process; Resources; Risk; Risk Reduction; Rural; Rural Community; Rural Population; Secondary to; Service provision; Services; Social Network; Societies; Sterility; Stimulant; Structure; Survey Methodology; Surveys; Syringes; Time; Urban Population; Work; addiction; base; digital; disease transmission; drug use behavior; experience; follow-up; implementation evaluation; implementation framework; improved; informant; injection drug use; innovation; learning community; methamphetamine use; mortality; opioid epidemic; opioid use; overdose death; overdose education; overdose risk; pandemic disease; polysubstance use; rural area; rural counties; rural drug use; rural setting; self testing; service delivery; service organization; service providers; severe mental illness; substance use; substance use treatment; synthetic opioid; test strip; trend; urban area

PROJECT SUMMARY Over the past two decades, rural counties in the U.S. have seen increasing rates of overdose death along with rising hepatitis C incidence and outbreaks of HIV linked to injection drug use. The rural opioid crisis is co- occurring and intertwined with evolving methamphetamine use and polysubstance use more broadly. The burden of morbidity and mortality related to substance use in the rural setting is exacerbated by the scarcity of resources such as addiction treatment, overdose education and naloxone distribution, syringe exchange, and other harm reduction services (HRS). Given the lack of biomedical treatment for methamphetamine use disorder, efforts to improve health outcomes for people who use methamphetamine hinge largely on harm reduction strategies. In the face of the pandemic grassroots HRS organizations have been challenged to adapt service delivery amidst sparse resources and shifting drug use behavior. The proposed study aims to understand evolving drug use and harm reduction behavior in rural settings, including those where polysubstance use with methamphetamine and fentanyl are prevalent, in order to inform the expansion of effective HRS within these communities. We will engage HRS providers and participants in a process of tailoring strategies for remote, contactless delivery of services, and evaluate their implementation. This study will explore individual, interpersonal, and community influences on engagement in harm reduction according to the socio-ecological model. In Aim 1, we will assess drug use, harm reduction behavior, and decision-making processes regarding harm reduction engagement and use and distribution of supplies among people who use drugs (PWUD). We will collect data through multiple methods including baseline surveys, two weeks of daily assessments using mobile phones, and semi-structured interviews with PWUD accessing HRS. In Aim 2, using social network survey methods as well as in depth qualitative interviews, we seek to understand the dynamics of secondary distribution by identifying the personal and social network characteristics of participant champions who may implement network interventions. In Aim 3, we will develop and evaluate the implementation of remote harm reduction service delivery including digital lock boxes and mail ordered supplies tailored to address structural barriers in rural settings. This process will include needs assessment through key informant interviews, guided discussion groups forming a learning community co-led by an HRS provider, and implementation and evaluation informed by the EPIS implementation framework. This work will provide foundational knowledge to develop practical harm reduction delivery strategies for rural areas facing disparate challenges in pandemic-era service provision as well as inform future network interventions for rural drug use characterized by methamphetamine and the ubiquitous presence of synthetic opioids.

项目摘要 在过去的二十年中，美国农村县的死亡率增加了 与注射药物使用有关的丙型肝炎发病率和艾滋病毒爆发。农村阿片类药物危机是共同的 与不断发展的甲基苯丙胺的使用和多物质使用更广泛地使用并交织在一起。负担 资源稀缺使在农村环境中与物质使用相关的发病率和死亡率加剧了 例如成瘾治疗，过量教育和纳洛酮分布，注射器交换以及其他危害 减少服务（HRS）。鉴于缺乏甲基苯丙胺使用障碍的生物医学治疗， 改善使用甲基苯丙胺铰链铰链铰链的人的健康状况，主要是减少损害策略。在 大流行基层人力资源组织组织的面孔受到挑战，以适应服务交付 稀疏的资源和转移吸毒行为。拟议的研究旨在了解不断发展的药物使用和 在农村环境中，危害减少行为，包括多甲基苯丙胺与甲基苯丙胺一起使用的行为 芬太尼很普遍，以告知这些社区内有效人力资源的扩展。我们将 让HRS提供者和参与者参与调整策略以远程，无接触式交付的过程 服务，并评估其实施。这项研究将探索个人，人际和社区 根据社会生态模型的影响减少伤害的影响。在AIM 1中，我们将评估 毒品使用，减少损害行为以及有关减少损害参与和的决策过程 使用药物的人（PWUD）中的用品使用和分配。我们将通过多个收集数据 包括基线调查，使用手机进行两周的每日评估以及半结构的方法 PWUD访问HRS的访谈。在AIM 2中，使用社交网络调查方法以及深度 定性采访，我们试图通过识别个人来理解次要分配的动态 可能实施网络干预的参与者拥护者的社交网络特征。目标 3，我们将开发和评估实施远程损害减少服务交付，包括数字 锁定箱子和邮寄订购的用品量身定制，以解决农村环境中的结构障碍。这个过程将 通过关键的线人访谈包括需求评估，指导讨论小组成立学习 由人力资源提供商共同领导的社区共同领导，并通过EPIC实施告知的实施和评估 框架。这项工作将提供基本知识来制定实际危害减少交付策略 对于面临大流行时代服务提供不同挑战的农村地区，并为未来的网络提供信息 以甲基苯丙胺为特征的农村药物使用干预措施和无处不在的合成 阿片类药物。