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

摘要 阿巴拉契亚地区农村和经济困难社区的阿片类药物滥用比率呈爆炸性增长 与之相关的健康后果，包括丙型肝炎和艾滋病毒，也在上升。有害的 阿片类药物的影响已受到全国的关注，但阿片类药物使用障碍蔓延的驱动因素(OUD) 而且跨社区的过量用药还不清楚。此外，两国之间相互交织的关系 注射类阿片类药物的使用和包括丙型肝炎和艾滋病毒感染在内的并存需要进一步 进行调查，为综合预防和干预工作提供信息。很少有研究使用深入的、 从当地社区利益相关者那里收集具有特定背景的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总体目标(为回应 RFA-DA-16-015)是为了审查阿片类药物流行的上下文和时间上的特定模式 宾夕法尼亚州西南部阿巴拉契亚北部地区定量和定性互补研究 接近了。我们建议使用一种混合的方法，结合大学和大学的空间分析。 过量住院和来自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 西南部阿巴拉契亚北部地区十个县的注射毒品使用情况 宾夕法尼亚州。这项提案的具体目的是：(1)描述阿片类药物的生长和传播 滥用、依赖和过量服药及其相关的共病(丙型肝炎病毒和艾滋病毒)随时间和空间的变化和(2) 确定与阿片类药物滥用、依赖和干预有关的资源和干预机会 一个“热点”社区内的过量用药和相关的共病。我们将结合16年的油井- 使用社区参与的方法和深入收集的定性数据解决空间数据 在有目的地抽样的目标案例社区中进行访谈。我们将从检查医院患者空间开始 邮政编码级别的数据，以衡量OUD和两种并存条件的地理增长和传播 (丙型肝炎病毒和艾滋病毒)，由季度住院数据(2000年至2015年)衡量。我们会 确定区域的特定属性(例如，经济条件)，以便于随着时间的推移在ZIP上传播 编码，并区分这些影响的时间尺度。空间随机效应模型和后验数据 这些模型将用于确定一个具有2015年邮政编码边界的“案例”社区 预测的共病疫情爆发的最大概率。在这种情况下，我们将确定社区和 与关键利益攸关方接触，包括临床医生和治疗提供者(重点关注阿片类药物、丙型肝炎病毒和艾滋病毒)，以及 其他人(例如，前阿片类药物注射使用者)通过滚雪球抽样确定。我们将使用定性的 采访20名线人，以确定交叉流行的驱动因素和现有资源和小说 干预机会。这项工作将为更大范围的面向行动的研究和规划奠定基础 阿巴拉契亚地区解决阿片类药物注射吸毒、丙型肝炎病毒和艾滋病毒问题的努力。

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.