Oregon HIV/Hepatitis and Opioid Prevention and Engagement (OR-HOPE) Study Cost Extension

项目摘要 俄勒冈州艾滋病毒/肝炎和阿片类药物预防和接触(OR-HOPE)研究是一项两项- 阶段(UG3和UH3)，多方法研究，以实施社区行动小组和同行农村 俄勒冈州农村阿片类药物过量、肝炎高危地区护理协调员干预 C，和HIV。这项研究利用了现有的和正在发展中的公共卫生和治疗 基础设施，以实施可持续的农村同伴关怀协调员(PCC)模式。在第一阶段 (UG3)，我们建立社区行动小组，审查和制定当地社区的反应 计划在2个高需求的农村县解决农村贫困人口问题及其后果。焦点小组和 与社区利益攸关方(初级保健提供者、公共卫生)进行定性访谈 官员、执法部门和受影响的社区成员)记录需求、资源和 确定响应计划实施的最佳实践。我们还评估了一项 PCC干预，以改善艾滋病毒、丙型肝炎检测和联系，以照顾OUD患者， 并送去疾控中心/幽灵实验室的确认性静脉抽液。随之而来的远程保健 干预措施支持初级保健提供者治疗OUD和丙型肝炎患者。 阶段1(UG3)的里程碑包括：1)制定社区应对计划，2)招生 初级保健提供者的远程保健支持，3)PCC干预的试点实施，以及 4)参与者的静脉采血样本成功送往疾控中心/幽灵实验室。在第二阶段，我们扩展- 将PCC干预扩大到8个农村县，评估PCC的改进效果 艾滋病毒和丙型肝炎检测，阿片类药物过量，以及与艾滋病毒、丙型肝炎和 阿片类药物使用障碍。阶梯式实施设计包括尚未启动的县 作为时间控制的干预。主要结果是1)艾滋病毒检测的次数 在干预县和非干预县进行。次要结果包括a) 过量服药率，b)开始艾滋病毒治疗，c)开始丙型肝炎治疗，d)开始乌德 治疗，e)HIV病毒抑制一年，和f)丙型肝炎持续病毒应答。 在阶段2中持续进行定性的利益相关者访谈，记录挑战和最佳 PCC干预和社区应对计划实施的做法。结果通知 开发新的、可持续的社区干预模式以减少OUD及其 对美国农村的影响。拟议的工作与美国国立卫生研究院艾滋病研究办公室保持一致 扩大艾滋病毒检测和参与艾滋病毒的治疗和治疗的优先事项 合并症。

Project Summary The Oregon HIV/Hepatitis and Opioid Prevention and Engagement (OR-HOPE) study is a two- phase (UG3 & UH3), multi-method study to implement community action teams and a peer rural care coordinator intervention in rural Oregon counties at high risk for opioid overdose, hepatitis C, and HIV. The study leverages existing and developing public health and treatment infrastructure to implement a sustainable rural peer care coordinator (PCC) model. In Phase 1 (UG3), we develop community action teams that review and develop local community response plans to address OUD and its consequences in 2 high-needs rural counties. Focus groups and qualitative interviews with community stakeholders (primary care providers, public health officials, law enforcement, and affected community members) document needs, resources, and identify best practices for response plan implementation. We also assess the feasibility of a PCC intervention to improve HIV, hepatitis C testing and linkage to care for people with OUD, and sending confirmatory phlebotomy to CDC/GHOST lab. A concomitant telehealth intervention supports primary care providers in treatment of patients with OUD and hepatitis C. Phase 1 (UG3) milestones include: 1) development of community response plans, 2) enrollment of primary care providers in telehealth support, 3) pilot implementation of PCC intervention, and 4) participant phlebotomy samples successfully sent to CDC/GHOST lab. In Phase 2, we scale- up the PCC intervention to 8 rural counties to assess the effectiveness of PCCs in improving HIV and hepatitis C testing, opioid overdose, and linkage to treatment for HIV, hepatitis C, and opioid use disorder. The step-wedge implementation design includes counties not yet initiating the intervention to serve as temporal controls. The primary outcome is 1) number of HIV tests performed in intervention versus non-intervention counties. Secondary outcomes include a) overdose rates, b) initiation of HIV treatment, c) initiation of HCV treatment, d) initiation of OUD treatment, e) HIV viral suppression at one year, and f) hepatitis C sustained viral response. Continued qualitative stakeholder interviews in Phase 2 document challenges and best practices for PCC intervention and community response plan implementation. The results inform development of novel and sustainable community intervention models to decrease OUD and its consequences in rural America. The proposed work aligns with NIH Office of AIDS Research priorities of expanding HIV testing and engagement in treatment, and treatment of HIV comorbidities.