Identifying Ecologically Valid Intervention Opportunities to Reduce Opioid Injection Drug Use in Southwestern Pennsylvania

摘要 在阿巴拉契亚地区的农村和经济贫困社区，阿片类药物滥用率呈爆炸式增长。 以及相关的健康后果，包括丙型肝炎（HCV）和艾滋病毒，也在上升。的有害 阿片类药物的影响受到了全国的关注，但阿片类药物使用障碍（OUD）蔓延的驱动因素 和吸毒过量的问题还不清楚此外， 注射阿片类药物使用和合并症，包括丙型肝炎和艾滋病毒感染， 为综合预防和干预工作提供信息。很少有研究使用了深入的， 从当地社区利益攸关方收集信息的生态有效方法， 应对疫情的经验。这项为期一年的规划研究补助金的整体目标（以回应 RFA-DA-16-015）的目的是检查阿片类药物流行病的背景和时间特异性模式， 宾夕法尼亚州西南部的北方阿巴拉契亚地区使用互补的定量和定性 接近。我们建议使用混合方法的方法，将空间分析的OUD和 过量住院和当地利益相关者的定性数据，以更好地了解阿片类药物的传播 在构成西南部阿巴拉契亚地区北方的十个县， 宾夕法尼亚本研究的具体目的是：（1）描述阿片类药物的增长和扩散 随时间和空间的滥用、依赖和过量以及相关合并症（HCV和HIV），以及（2） 确定与阿片类药物滥用、依赖和 在一个“热点”社区内的药物过量和相关合并症。我们将把联合收割机16年来- 解决空间数据与定性数据收集使用社区参与的方法和深入 在有目的抽样的目标案例社区进行访谈。我们将从检查医院病人的空间开始， 邮政编码级别的数据，以衡量OUD和两种共病的地理增长和传播 (HCV和艾滋病毒），通过64个季度的住院患者住院数据（从2000年到2015年）来衡量。我们将 识别区域的特定属性（例如，经济条件），促进跨ZIP的时间传播 代码，并区分这些影响的时间规模。空间随机效应模型和后验 这些模型将用于确定一个“案例”社区（由2015年邮政编码边界定义）， 共病流行病爆发的最大预测概率。在这种情况下，我们将识别社区， 让关键利益相关者参与，包括临床医生和治疗提供者（重点关注阿片类药物、HCV和HIV），以及 其他人（如前类阿片注射使用者）通过滚雪球抽样确定。我们将使用定性 采访了20名知情人，以确定交叉流行病的驱动因素和现有资源， 干预机会。这项工作将为更大规模的面向行动的研究和规划奠定基础 在阿巴拉契亚地区，努力解决阿片类注射吸毒、丙型肝炎病毒和艾滋病毒问题。

ABSTRACT Opioid abuse rates are exploding in rural and economically distressed communities in the Appalachian region and associated health consequences, including Hepatitis C (HCV) and HIV, are also on the rise. The harmful impact of opioids have received national attention, yet the drivers of the spread of opioid use disorders (OUD) and overdose across communities are not yet understood. In addition, the intertwined relationship between injection opioid drug use and co-morbidities including Hepatitis C and HIV infection necessitate further investigation to inform integrated prevention and intervention efforts. Few studies have used an in-depth, ecologically valid approach to collect information from local community stakeholders with contextually specific experience addressing the epidemic. The overall goal of this one-year planning research grant (in response to RFA-DA-16-015) is to examine contextually- and temporally-specific patterns of the opioid epidemic in the Northern Appalachian Region of Southwestern Pennsylvania using complementary quantitative and qualitative approaches. We propose to use a mixed methods approach incorporating spatial analyses of OUD and overdose hospitalizations and qualitative data from local stakeholders to better understand the spread of opioid injection drug use in the ten counties that make up the Northern Appalachian Region of Southwestern Pennsylvania. The Specific Aims of this proposal are: (1) To characterize the growth and spread of opioid drug abuse, dependence, and overdose and associated co-morbidities (HCV and HIV) over time and space and (2) To identify resources and intervention opportunities associated with opioid drug abuse, dependence, and overdose and associated co-morbidities within one “hot spot” community. We will combine 16 years of well- resolved spatial data with qualitative data to be collected using a community engaged approach and in-depth interviews in a purposefully sampled target case community. We will start by examining hospital patient spatial data at the ZIP code level to measure the geographic growth and spread of OUD and two comorbid conditions (HCV & HIV) as measured by 64 quarters of inpatient hospitalization data (from 2000 through 2015). We will identify specific attributes of areas (e.g., economic conditions) that facilitate spread over time across ZIP codes, and distinguish the temporal scale of these impacts. Spatial random effects models and posteriors from these models will be used to identify one “case” community (defined by 2015 ZIP code boundaries) with the greatest predicted probability of comorbid epidemic outbreak. In this case community we will identify and engage key stakeholders, including clinicians & treatment providers (focused on opioids, HCV, and HIV), and others (e.g. former opioid injection users) identified through snowball sampling. We will use qualitative interviews with 20 informants to identify drivers of the intersecting epidemics and existing resources and novel intervention opportunities. This work will lay the foundation for larger action-oriented research and planning efforts addressing opioid injection drug use, HCV and HIV in the Appalachian region.