Vending machine Naloxone Distribution for Your community (VENDY): Increasing reach and implementation of naloxone distribution

项目总结/摘要 去年阿片类药物过量死亡人数增加了30%以上。旁观者访问 纳洛酮药物有效地逆转阿片类药物过量死亡，不良事件有限。但目前的 纳洛酮分配策略是缺少阿片类药物过量高风险的个体。自动售货机 这是一项创新战略，旨在扩大欧洲减少危害服务的覆盖范围。的年轻人 目睹或经历过阿片类药物过量，表达了对纳洛酮自动售货机的渴望， 建筑环境的特征（包括安全性和位置）作为促进使用的感知因素。那里 在美国，纳洛酮自动售货机受到广泛关注。然而，实施挑战已经放缓 减少或有限的采用，包括引导利益相关者批准和确定适当的位置， 安置本提案的目的是研究社区发起、利益攸关方参与的 纳洛酮分配，自动售货机纳洛酮分配为您的社区（VENDY），以增加 纳洛酮在有阿片类药物过量风险的服务不足人群中的可及性。研究目的包括： 目标1：在3个服务水平低下的社区（2个城市和1个农村）， 迭代的以用户为中心的设计（UCD）实施策略和利益相关者的参与，以增加 覆盖面、实施和可持续性。我们将使用迭代可用性和消息测试来完善 与滥用阿片类药物的社区成员合作。我们将进行调查和定性访谈 与利益相关者一起完善UCD实施战略以供将来使用。 目标2：在2个城市和1个农村社区对VENDY方案进行为期6个月的试点评估。 该试点包括中期适应和范围、有效性、采用、实施 和维持（RE-AIM）结果。 目标3：确定社会和建筑环境中有助于实现和执行 VENDY计划使用photovoice定性评估与组织实施者和社区 目前正在使用阿片类药物。Photovoice评估将在目标1的潜在地点进行， 在目标2中的VENDY位置和VENDY位置，通知利益相关者调整。 以社区为基础的方法，如VENDY，对于接触目前尚未使用的阿片类药物使用者特别重要。 参与卫生系统。为了实现这些目标，瓦格纳博士将继续接受以下培训：1）以用户为中心 设计，创新的实施战略，2）在不同环境中进行务实的试验，以及3） 评估建筑和社会环境及其对覆盖面和实施的影响。这一指导 研究项目和职业发展计划的目的是准备博士。瓦格纳成为一个领导者， 调整针对药物使用的有效干预措施，以更好地覆盖得不到充分服务的人口， 建立可持续的实施模式。

PROJECT SUMMARY/ABSTRACT There has been more than a 30% increase in opioid overdose deaths in the last year. Bystander access to naloxone medication effectively reverses opioid overdose deaths with limited adverse events. However, current naloxone distribution strategies are missing individuals at high risk of opioid overdose. Vending machines are an innovative strategy shown to increase reach of harm reduction services in Europe. Young adults who witnessed or experienced an opioid overdose expressed a desire for naloxone vending machines but identified features of the built environment (including safety and location) as perceived factors contributing to use. There is widespread interest in naloxone vending machines in the U.S. Yet, implementation challenges have slowed down or limited adoption including navigating stakeholder approvals and identifying appropriate locations for placement. The aim of this proposal is to study a community-initiated, stakeholder engaged adaptation of naloxone distribution, VEnding machine Naloxone Distribution for Your community (VENDY), to increase the reach of naloxone in underserved populations at-risk of opioid overdose. Study Aims include: Aim 1: To refine the VENDY program in 3 underserved communities (2 urban and 1 rural) using an iterative user centered design (UCD) implementation strategy and stakeholder engagement to increase reach, implementation, and sustainability. We will use iterative usability and message testing to refine the program with community members who misuse opioids. We will conduct surveys and qualitative interviews with stakeholder to refine the UCD implementation strategy for future use. Aim 2: Conduct a 6 month pilot assessment of the VENDY program in 2 urban and 1 rural community. The pilot includes a midcourse adaptation and evaluation of reach, effectiveness, adoption, implementation and maintenance (RE-AIM) outcomes. Aim 3: Identify factors in the social and built environment contributing to reach and implementation of the VENDY program using photovoice qualitative evaluations with organization implementers and community members currently using opioids. Photovoice evaluations will occur in potential locations in Aim 1 to inform VENDY placement and in the VENDY location in Aim 2 to inform stakeholder adaptations. Community-based approaches such as VENDY are particularly important to reach opioid users not currently engaged with health systems. To accomplish these aims, Dr. Wagner will pursue training in 1) user centered design, an innovative implementation strategy, 2) conduct of pragmatic trials in diverse settings, and 3) assessment of the built and social environment and its effect on reach and implementation. This mentored research project and career development plan are designed to prepare Dr. Wagner to become a leader in the adaptation of effective interventions addressing substance use to better reach underserved populations and to produce sustainable implementation models.