Kentucky Communities and Researchers Engaging to Halt the Opioid Epidemic (CARE2HOPE)

摘要：拟议的项目将建立以证据为基础、以社区为基础的公共卫生应对措施 非医用处方阿片类药物(NMPO)和海洛因注射、过量(OD)和丙型肝炎病毒(丙型肝炎)的流行，以及 迫在眉睫的艾滋病毒暴发，在阿巴拉契亚肯塔基州12个农村县的震中这些交织在一起 国家危机。在这12个县中，有10个县的艾滋病毒/丙型肝炎病毒易感性排名前5%。丙型肝炎病毒注射率 毒品使用(IDU)和ODD在这些县很高，而且大多数在煤炭国家，这是RFA的优先事项。 不幸的是，这些县是“执行鸿沟”的一个极端版本，一个鸿沟 把科学知识和行动分开。存在针对这些流行病的循证公共卫生对策 (例如，注射器服务计划[SSP])，并经常部署在城市中。然而，在这12个农村县， 资源和提供者的匮乏与与毒品有关的污名共同制约了公共卫生的反应。 这些县的公共卫生基础设施薄弱，其减少危害的基础设施几乎不存在。 该项目将在这12个县弥合执行鸿沟，并认识到弥合这一鸿沟 CHASM需要的不仅仅是简单地引入SSP和其他以证据为基础的社区应对项目 (EB-CRPS)来自城市。以减少危害原则、风险环境模型和社区/ 学术伙伴关系(CAPS)，在UG3中，我们将：(1)评估和加强每个国家的准备情况 改善地方风险环境。(2)检查各县的优势、资源、需求和差距 风险环境。我们将对风险环境进行多方法社区评估， 整合创新、严格的流行病学(例如，建模)、政策评估和最佳做法 基于社区的研究(例如，CAPS)。(3)选择一种符合当地需要和优势的EB-CRP， 使用干预地图的要素。通过/不通过里程碑：每个CAP都将创建一个EB-CRP (1)针对所有县的共同目标(例如，阿片类药物注射、OD、丙型肝炎病毒、艾滋病毒)的一揽子计划，以及(2) 根据当地需求、资源和准备情况量身定做。在UH3中，我们将：(4)裁剪选择EB-CRP 使用Adapt-ITT的县背景。(5)分析各县EB-CRP方案的效果和成本。 使用一项创新的社区随机试验。我们将用持续的质量改进来提升每一个 EB-CRP的保真度、可达性、即刻效果和结果。为干预提供信息，先进的网络 分析将用幽灵系统发育传播数据覆盖风险网络，以显示丙型肝炎病毒的去向 并预测它的去向。我们从合作中汲取力量。上限将融合当地居民的 具有研究人员科学专长的知识。杨和库珀已经召集了一位学者 在关键内容、理论和方法以及多点研究方面拥有无与伦比的专业知识的团队。这个 严谨、创新的设计、强大的理论和扎根于社区的优秀团队的结合 确保高影响力。

Abstract: The proposed project will build evidence-based, community-rooted public health responses to the epidemics of non-medical prescription opioid (NMPO) and heroin injecting, overdoses (ODs), and HCV, and to imminent HIV outbreaks, in 12 rural Appalachian Kentucky counties at the epicenter of these intertwined national crises. 10 of these 12 counties rank in the top 5% for HIV/HCV vulnerability. Rates of HCV, injection drug use (IDU), and ODs are high in these counties, and most are in coal country, an RFA priority. Unfortunately, these counties exemplify an extreme version of the “implementation chasm,” a chasm dividing scientific knowledge from action. Evidence-based public health responses to these epidemics exist (e.g., syringe service programs [SSPs]) and are often deployed in cities. In these 12 rural counties, though, scarcities of resources and of providers conspire with drug-related stigma to constrain public health responses. The counties’ public health infrastructures are weak, their harm reduction infrastructures virtually non-existent. This project will bridge the implementation chasm in these 12 counties, and recognizes that bridging this chasm requires more than simply importing SSPs and other evidence-based community response projects (EB-CRPs) from cities. Guided by harm reduction principles, the Risk Environment Model, and Community/ Academic Partnerships (CAPs), in the UG3 we will: (1) Assess and enhance each county’s readiness to improve the local risk environment. (2) Examine the strengths, resources, needs, and gaps of each county’s risk environment. We will conduct a multi-method Community Assessment of the Risk Environment that integrates innovative, rigorous epidemiology (e.g., modeling); policy assessment; and best practices in community-based research (e.g., CAPs). (3) Select an EB-CRP that responds to local needs and strengths, using elements of Intervention Mapping. Go/no go milestone: Each CAP will have created an EB-CRP package that (1) addresses targets common across all counties (e.g., opioid injection, OD, HCV, HIV), and (2) is tailored to local needs, resources, and readiness. In the UH3, we will: (4) Tailor selected EB-CRP to each county’s context using ADAPT-ITT. (5) Analyze the effectiveness and cost of each county’s EB-CRP package, using an innovative community randomized trial. We will use continuous quality improvement to enhance each EB-CRP’s fidelity, reach, immediate effects, and outcomes. To inform interventions, advanced network analyses will overlay risk networks with GHOST phylogenetic transmission data to show where HCV has been and predict where it is going. We draw strength from our collaborations. CAPs will meld residents’ local knowledge with researchers’ scientific expertise. Multi-PIs Young and Cooper have assembled an academic team with unsurpassed expertise in key substance, theories, and methods, and in multisite studies. The combination of a rigorous, innovative design, strong theories, and a stellar team with community roots will ensure high impact.