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.

项目概要 在过去的二十年里，美国农村地区的服药过量死亡率不断上升， 丙型肝炎发病率上升和艾滋病毒爆发与注射吸毒有关。农村阿片类药物危机是共同的 其发生并与不断发展的甲基苯丙胺使用和更广泛的多物质使用交织在一起。负担 资源稀缺加剧了农村地区与药物使用相关的发病率和死亡率 例如成瘾治疗、过量教育和纳洛酮分发、注射器交换和其他伤害 减少服务（HRS）。鉴于缺乏对甲基苯丙胺使用障碍的生物医学治疗，努力 改善甲基苯丙胺使用者的健康结果很大程度上取决于减少危害的策略。在 面对大流行病，基层人力资源服务组织面临着调整服务交付的挑战 资源稀缺和吸毒行为的转变。拟议的研究旨在了解不断变化的药物使用和 农村环境中的减少危害行为，包括使用多物质与甲基苯丙胺和 芬太尼很普遍，以便为这些社区内扩大有效的 HRS 提供信息。我们将 让 HRS 提供商和参与者参与制定远程、非接触式交付策略的过程 服务，并评估其实施情况。本研究将探讨个人、人际和社区 根据社会生态模型对参与减少危害的影响。在目标 1 中，我们将评估 药物使用、减少伤害行为以及有关减少伤害参与和决策的决策过程 吸毒者 (PWUD) 中用品的使用和分配。我们将通过多种方式收集数据 方法包括基线调查、使用手机进行两周的每日评估以及半结构化 对访问 HRS 的 PWUD 进行采访。目标2，利用社交网络调查方法以及深度调查 定性访谈中，我们试图通过识别个人来了解二次分配的动态 以及可能实施网络干预的参与者倡导者的社交网络特征。瞄准 3、我们将开发和评估远程减害服务交付的实施情况，包括数字化 专为解决农村地区的结构性障碍而设计的锁箱和邮购用品。这个过程将 包括通过关键知情者访谈进行需求评估，引导讨论小组形成学习 由 HRS 提供商共同领导的社区，以及由 EPIS 实施提供信息的实施和评估 框架。这项工作将为制定实际的减少伤害实施策略提供基础知识 为在大流行时代提供服务方面面临不同挑战的农村地区以及为未来网络提供信息 对以甲基苯丙胺和普遍存在的合成毒品为特征的农村毒品使用的干预措施 阿片类药物。