Ending transmission of HIV, HCV, and STDs and overdose in rural communities of people who inject drugs (ETHIC)

摘要 中西部农村地区的艾滋病毒和丙型肝炎病毒的爆发与以下因素有关： 注射非医疗处方阿片类药物的伴侣伊利诺斯州是美国人口比例第三高的州 2014-2015年期间涉及合成阿片类药物的死亡率增加。最南端的16个县 伊利诺伊州包括伊利诺伊州三角洲地区（IDR），并分享许多农村地区的特点， 经历了最近的艾滋病毒流行。更深入地了解社区特征，包括过渡 从口服到注射阿片类药物的使用，高风险注射做法的情况，以及现有和 潜在的卫生相关资源对于发展疾病预防和治疗模式至关重要。 与州和地方公共卫生机构、其他州机构、社区项目、地方联盟合作 和医疗保健系统，我们将采取混合分析方法，使用预测建模，GIS分析， 定性和调查分析，网络方法，传染病流行病学了解 地理空间和社会文化因素影响IDR中注射毒品者的健康结果。这些 数据将为基于证据的干预措施提供信息，以加强疾病筛查的获取和与护理的联系 和治疗，扩大针头交换和纳洛酮过量计划，筛查和转诊， 物质使用治疗和远程保健能力建设，以提供PrEP，HCV管理， 药物辅助治疗物质使用障碍。 UG 3目标1.确定伊利诺伊州三角洲地区农村地区阿片类药物滥用风险最大的地理区域 根据疾病监测、医疗保健利用、处方药 监测、逮捕和缉获毒品，以及资源稀缺情况测绘。 2.第二章了解社会文化因素如何影响风险和寻求健康的行为，社交网络， 在目标1所确定的高风险地理区域，注射吸毒者的疾病传播。 3.第三章整合和应用流行病学、地理空间、定性和网络数据， 扩大减少伤害服务，并针对相关临床护理开展远程保健能力建设。 UH3 Aim 1.扩大减少伤害服务，包括注射器服务，纳洛酮过量预防， 药物使用治疗转诊、艾滋病毒、丙型肝炎病毒、乙型肝炎病毒和性传播疾病检测以及通过能力与护理挂钩 建立现有的方案，以及通过新的地方卫生部门的减少危害单位。 2.建立HCV管理、PrEP、物质使用筛查、转诊和药物治疗的能力- 通过针对残疾人首选环境的远程保健方案提供辅助治疗。 3.根据CDC RE-AIM框架评估项目实施情况， 利益攸关方、州和地方一级服务的整合和协调以及供资的可持续性。

ABSTRACT Outbreaks of HIV and HCV in rural areas of the Midwest have been associated with syringe-sharing among partners injecting nonmedical prescription opioids. Illinois ranks as the third highest state in percentage increase in death rates involving synthetic opiates between 2014-2015. The southernmost 16 counties of Illinois comprise the Illinois Delta Region (IDR) and share many of the characteristics of rural areas that have experienced recent HIV epidemics. A deeper understanding of community characteristics, including transitions from oral to injection opioid use, circumstances for high-risk injection practices, and accessibility to existing and potential health-related resources will be essential to developing models of disease prevention and treatment. Partnering with state and local public health other state agencies, community based programs, local coalitions and healthcare systems, we will take a mixed analytical approach using predictive modeling, GIS analysis, qualitative and survey analysis, network methods, and infectious disease epidemiology to understand geospatial and sociocultural factors impacting health outcomes in people who inject drugs in the IDR. These data will inform evidence-based interventions to strengthen access to disease screening and linkage to care and treatment, expansion of needle exchange and naloxone overdose programs, screening and referral to substance use treatment, and telehealth capacity building for the provision of PrEP, HCV management, and medication-assisted treatment for substance use disorder. UG3 Aim 1. Determine the geographic areas in the rural Illinois Delta Region at greatest risk for opioid misuse and infectious diseases in the IDR based on disease surveillance, healthcare utilization, prescription drug monitoring, arrest and drug seizure, and resource scarcity mapping. UG3 Aim 2. Understand how sociocultural factors impact risk and health seeking behaviors, social networks, and disease transmission of people who inject drugs in high risk geographic areas identified in Aim 1. UG3 Aim 3. Integrate and apply the epidemiological, geospatial, qualitative and network data to inform expanded harm-reduction services and targeted telehealth capacity building for related clinical care. UH3 Aim 1. Expand harm reduction services including syringe services, naloxone overdose prevention, substance use treatment referral, HIV, HCV, HBV and STDs testing and linkage to care through capacity building of existing programs as well as through new local health department based harm reduction units. UH3 Aim 2. Build capacity for HCV management, PrEP, substance use screening, referral, and medication- assisted treatment through telehealth programs targeted at PWID-preferred settings. UH3 Aim 3. Evaluate program implementation based on CDC RE-AIM framework, continued engagement of stakeholders, integration and coordination of services at the state and local level, and sustainability of funding.