The Influence of Spatial Proximity to Sterile Syringe Sources and Secondary Syringe Exchange on HCV Risk Among Rural People Who Inject Drugs

项目摘要/摘要 目前美国阿片类药物的流行推动了注射毒品使用量的增加，进而引发了令人震惊的激增 新增丙型肝炎病毒(丙型肝炎病毒)感染。2010至2015年间，丙型肝炎病毒的发病率增加了294% 在全国范围内，主要是由注射毒品使用和危险注射行为--即共用注射器--的增加推动的。 这一日益增长的流行病对农村注射毒品(PWID)的年轻人造成了不成比例的影响 社区。迫切需要对农村实施有针对性的、有效的减害战略 受丙型肝炎病毒影响不成比例的PWID患者。尽管研究表明，注射器服务和 药房注射器销售(即无菌注射器来源)与注射介导性风险的降低有关 关于这些服务是否可以降低PWID中的丙型肝炎风险，以及艾滋病毒的传播，证据仍然喜忧参半。 该建议将应用风险环境模型来评价无菌注射器来源对环境的影响 丙型肝炎病毒的风险环境。具体地说，这项提案将评估空间上是否接近无菌注射器 来源和接受二次注射器交换与农村PWID中的丙型肝炎病毒血清状态有关。 其目的是：(1)评估公路网距离最近的无菌注射器之间的关联 来源(SSP或销售非处方药注射器的药店)和丙型肝炎病毒血清状态；(2)使用自我中心 社会网络分析评估接受二次注射器交换与丙型肝炎病毒感染的关系 (3)探索和了解农村残疾人对注射器获取和使用的认知和经验； 通过深入访谈分享注射器的做法。这些发现可能有助于了解 未来在新英格兰农村地区的减少伤害干预措施，这个国家的地区一直特别 受到阿片类药物流行和相关的丙型肝炎病毒感染的沉重打击。

PROJECT SUMMARY / ABSTRACT The current U.S. opioid epidemic has fueled an increase in injection drug use and, in turn, an alarming surge in new hepatitis C virus (HCV) infections. Between 2010 and 2015, the incidence of HCV increased by 294% nationally, driven primarily by a rise in injection drug use and risky injection behavior – namely syringe sharing. This growing epidemic has disproportionately affected young people who inject drugs (PWID) in rural communities. There is an urgent need to implement tailored and effective harm reduction strategies to rural PWID who are disproportionately impacted by HCV. Although research has shown that syringe services and pharmacy syringe sales (i.e sterile syringe sources) are associated with a reduction in injection-mediated risks and HIV transmission, the evidence for whether these services reduce HCV risk among PWID remains mixed. This proposal will applying the risk environment model to evaluate the influence of sterile syringe sources on the HCV risk environment. Specifically, this proposal will evaluate whether spatial proximity to sterile syringe sources and receptive secondary syringe exchange are associated with HCV serostatus among rural PWID. The aims are: (1) To evaluate the association between road network distance to the nearest sterile syringe source (SSP or pharmacy that sells nonprescription syringes) and HCV serostatus; (2) To use egocentric social network analysis to evaluate the association between receptive secondary syringe exchange and HCV serostatus; (3) to explore and unpack rural PWIDs’ perceptions of and experiences with syringe acquisition and syringe sharing practices through in-depth interviews. These findings could help inform the development of future harm reduction interventions in rural New England, a region of the country that has been particularly hard hit by the opioid epidemic and related HCV infections.