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

项目摘要 在过去的二十年里，美国农村县的过量死亡率沿着在上升， 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， 发生并与不断变化的甲基苯丙胺使用和更广泛的多种物质使用交织在一起。负担 农村地区与药物使用有关的发病率和死亡率因资源稀缺而加剧 例如戒毒治疗、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， 改善甲基苯丙胺使用者的健康结果在很大程度上取决于减少危害战略。在 面对大流行，基层HRS组织面临着调整服务提供的挑战， 资源匮乏和吸毒行为的转变。这项拟议的研究旨在了解不断变化的药物使用， 在农村环境中减少危害的行为，包括那些与甲基苯丙胺一起使用多种物质的地方， 芬太尼是普遍存在的，以便为在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定制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、减少危害行为以及有关减少危害参与的决策过程， 在吸毒者中使用和分配用品（PWUD）。我们将通过多个渠道收集数据 方法包括基线调查，使用移动的电话进行为期两周的日常评估， 与PWUD访问HRS的访谈。在目标2中，使用社会网络调查方法以及深入 通过定性访谈，我们试图通过识别个人信息来了解二次分配的动态 以及可能实施网络干预的参与者冠军的社会网络特征。在aim中 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 锁箱和邮购用品，以解决农村地区的结构性障碍。这一进程将 包括通过与主要信息提供者面谈进行需求评估， 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.这项工作将提供基础知识，以制定切实可行的减少危害交付战略 针对在流行病时期提供服务方面面临不同挑战的农村地区， 针对以甲基苯丙胺和普遍存在的合成苯丙胺为特点的农村吸毒的干预措施 阿片类药物

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.