Effect of structural interventions on substance use and HIV/HCV risk among rural PWUD

 描述(由申请人提供)：本次续签申请(R01DA033862)的首要目标是确定结构性干预措施对阿巴拉契亚农村吸毒者参与降低风险和促进健康活动的影响。调查人员寻求继续进行的为期三年的R01的结果揭示了处方药滥用的不断变化的格局；一种仍处于初级阶段的流行病。与许多农村和郊区不同的是，几乎没有证据表明海洛因滥用正在转变。在这个队列中，从滥用OxyContin(R)(缓释羟考酮)到立即释放羟考酮，再到最近的丁丙诺啡和含加巴喷丁的产品，已经有了显著的转变。此外，丙型肝炎的患病率和发病率很高，特别是考虑到阿巴拉契亚农村的人口密度。鉴于阿片类药物滥用和传染病传播的共同特点，两种结构性干预措施与这一使用毒品的农村人口特别相关 (PWUD)。扩大医疗补助(MC)(根据《平价医疗法案》[ACA])和注射器获取计划(SAP)是两种结构性干预措施，可能会增加PWUD对健康促进的参与，但可能受到个人、网络和社区层面因素的严重影响。利用拉特金的动态社会系统模型，并利用现有的、非常成功的农村PWUD队列，目的包括：1)检查这些结构性干预的动态因素如何影响非法和处方的纵向趋势 2)确定这些结构性干预措施对艾滋病毒/丙型肝炎发病率的影响和参与降低风险；以及3)评估这些结构性干预措施对药物滥用治疗的影响。这项研究具有非常重要的意义，因为了解这些特定的结构性干预措施影响健康促进的机制是改善阿巴拉契亚农村公共卫生的关键。药物滥用和丙型肝炎病毒是这一地区面临的两个最重要的健康问题，如果不是最重要的问题，该地区已经受到明显的健康差距的困扰。使用网络和地理空间风险的创新措施，以及联合分析和多层次纵向统计模型，结果将不会 仅为优化SAP和药物滥用治疗等降低风险服务的吸收和利用的干预措施的发展提供信息，但可能为围绕在美国农村进一步实施健康促进计划的政策提供信息。

 DESCRIPTION (provided by applicant): The overarching goal of this renewal application (R01DA033862) is to determine the influence of structural interventions on engagement in risk reduction and health promotion activities among rural Appalachian drug users. Results from the three-year R01 that the investigators seek to continue reveal an ever-changing landscape of prescription drug abuse; an epidemic that is still in its infancy. Unlike many rural and suburban areas, there is little evidence for the transition to heroin abuse. In this cohort, there has been marked shift from abuse of OxyContin(r) (extended-release oxycodone) to immediate release oxycodone to more recently, buprenorphine and gabapentin-containing products. In addition, rates of HCV prevalence and incidence are high, especially given the population density of rural Appalachia. Given the syndemic of opioid abuse and infectious disease transmission, two structural interventions are particularly relevant to this population of rural people who use drugs (PWUD). Medicaid (MC) expansion (under the Affordable Care Act [ACA]) and syringe access programs (SAP) are two structural interventions that may allow for increased engagement in health promotion among PWUD, but are likely heavily influenced by individual, network, and community-level factors. Utilizing Latkin's Dynamic Social Systems model and leveraging the extant, highly successful cohort of rural PWUD, the aims include: 1) examining how dynamic factors of these structural interventions influence longitudinal trends in illicit and prescription drug abuse; 2) determining the influence of these structural interventions on HIV/HCV incidence and engagement in risk reduction; and 3) assessing the influence of these structural interventions on uptake of substance abuse treatment. This study is highly significant given that understanding the mechanisms by which these specific structural interventions influence health promotion is key to improving public health in rural Appalachia. Substance abuse and HCV are two of the most important, if not the most important health issues facing this region already plagued with marked health disparities. Using innovative measures of network and geospatial risk, as well as conjoint analysis and multilevel longitudinal statistical models, results will not only inform development of interventions that optimize uptake and utilization of risk reduction services such as SAP and substance abuse treatment, but may inform policies surrounding further implementation of health promotion programs in the rural U.S.