Leveraging CDC Opioid Overdose Surveillance Funding from the Albuquerque Area Southwest Tribal Epidemiology Center to Create Tribal Data and Culturally Center Medications for Opioid Use Disorder

项目摘要/摘要 美洲印第安人/阿拉斯加原住民的致命阿片类药物过量比率高于西班牙裔， 非洲裔美国人和亚裔美国人，仅次于非西班牙裔白人。AI/AN阿片类药物过量使用率 各州和县的差异很大；然而，由于以下原因，很难确定部落级别的差异 分散的数据系统，将国家健康数据和印度健康服务数据分开。而县级 健康数据经常被用作部落数据的代理，州数据经常错误地对AN/AN患者进行分类，并且在县 由于包含多个部落的土地，县数据可能会模糊部落间的显著差异。除了有限的 部落特定的数据，阿片类药物使用障碍的治疗也往往无法解释部落的多样性 人口。平均而言，服用阿片类药物的患者使用障碍(Moud)，特别是 与美沙酮或丁丙诺啡相比，美沙酮或丁丙诺啡表现出更好的治疗保留和降低药物过量的风险 给没有服用莫德的病人。一些研究还表明，另一种Moud，纳曲酮的保留率有所改善。 因为Moud干预很少针对AI/AN患者的特定文化背景而量身定做，社会和 在人工智能/人工智能社区，治疗的文化障碍依然存在。为了解决这些问题，我们建议利用 疾病控制中心向阿尔伯克基地区西南部落流行病学中心提供资金 (AASTEC)在一项两阶段研究中提高新墨西哥州阿片类药物过量监测的数据质量 项目。该项目将利用一个由临床医生和印度卫生机构组成的社区咨询委员会 工作人员，并使用来自AASTEC和新墨西哥州卫生部的流行病学家的合作，以及 犹他大学、新墨西哥大学和哥伦比亚大学的学术研究人员。在第一个 阶段，我们将通过链接和地理编码来提高AI/AN阿片类药物使用障碍和过量数据的部落特异性 新墨西哥州生命统计和综合症监测数据。然后，我们将在预测模型中使用这些数据来 确定可改变的风险和保护因素对特定部落社区的作用。我们将传播 向部落社区提交分析报告，并寻求与部落和印度卫生机构建立第二个伙伴关系 我们研究的阶段，这需要一个基于社区的参与性研究项目，该项目将开发和测试 一个以文化为中心的Moud实施计划，用于AI/AN社区。我们将使用阶梯 在四个印度卫生机构中进行楔形随机设计，以测试开始、保留、复发和可接受 随着时间的推移，穆德在患者和诊所工作人员中以文化为中心。拟议的研究将加强 部落社区、AASTEC和学术研究人员之间的伙伴关系，并更好地协调阿片类药物研究 有部落价值观和优先事项。我们预计，我们的研究不仅会在学术期刊上发表文章 但也将产生用于为其他地区创建特定于部落的数据估计的工具包，以及用于文化的协议 以Moud为中心，了解其他人工智能/人工智能社区和印度卫生设施的背景。

Project Summary/Abstract Fatal opioid overdose rates are higher among American Indian/Alaska Native populations than among Hispanics, African Americans, and Asian Americans, and are just below non-Hispanic Whites. AI/AN opioid overdose rates vary significantly by state and county; however, tribe-level differences are difficult to ascertain due to decentralized data systems that divide state health data and Indian Health Service data. While county-level health data is often used as a proxy for tribal data, state data often misclassify AN/AN patients, and in counties containing the lands of multiple tribes, county data may blur significant inter-tribal variation. In addition to limited tribe-specific data, treatment for opioid use disorders also often fails to account for the diversity of tribal populations. On average, patients who take medication for opioid use disorder (MOUD), and specifically methadone or buprenorphine, exhibit improved treatment retention and reduced risk of drug overdose compared to patients not taking MOUD. Some research also shows improved retention for Naltrexone, another MOUD. Because MOUD interventions are rarely tailored to the specific cultural contexts of AI/AN patients, social and cultural barriers to treatment persist in AI/AN communities. To address these problems, we propose to leverage Center for Disease Control funding awarded to the Albuquerque Area Southwest Tribal Epidemiology Center (AASTEC) for improving data quality in opioid overdose surveillance in New Mexico in a two-phase research project. The project will draw upon a community advisory board composed of clinicians and Indian health facility staff, and use a collaboration of epidemiologists from AASTEC and the New Mexico Department of Health, and academic researchers at the University of Utah, University of New Mexico, and Columbia University. In the first phase, we will enhance tribal specificity of AI/AN opioid use disorder and overdose data by linking and geocoding New Mexico vital statistics and syndromic surveillance data. We will then use these data in predictive models to determine the role of modifiable risk and protective factors for specific tribal communities. We will disseminate analysis reports to tribal communities and seek partnerships with tribes and Indian health facilities for the second phase of our research, which entails a community-based participatory research project that will develop and test a culturally centered implementation program for MOUD for use in AI/AN communities. We will use a stepped wedge randomized design in four Indian health facilities to test initiation, retention, relapse, and acceptability of culturally centered MOUD among patients and clinic staff over time. The proposed research will strengthen partnerships between tribal communities, AASTEC, and academic researchers, and better align opioid research with tribal values and priorities. We anticipate our research will not only result in publications in academic journals but will also result in toolkits for creating tribe-specific data estimates for other regions, and protocols for culturally centering MOUD for the contexts of other AI/AN communities and Indian health facilities.