Implementing a Community-Based Response to the Opioid Epidemic in Rural Ohio

项目摘要/摘要 俄亥俄州正在经历全国最严重的阿片类药物注射流行之一。这场流行病已经严重地 影响到俄亥俄州南部阿巴拉契亚地区的农村县，导致过量死亡人数激增。俄亥俄州的海洛因- 相关的过量服药率是全国的五倍。除了过量死亡外，丙型肝炎病毒的死亡人数增加了400% 2009年至2013年，新生儿禁欲综合症(NAS)在2004年至2014年间增加了9倍。许多 循证干预(EBI)，如注射器服务计划，药物辅助治疗 药物使用，为过量治疗提供纳洛酮，以及检测丙型肝炎病毒、艾滋病毒和性传播 众所周知，性病对打击注射吸毒成瘾及其后果是有效的。 不幸的是，人们对如何将从城市注射毒品流行中吸取的经验教训应用到稀少的-- 人口稠密的农村地区。在俄亥俄州的农村，就像在美国的大部分地区一样，EBI的交付是有限的或分散的。匮乏 关键机构之间的协调，以解决服务方面的重叠和差距，特别是在 资源严重受限，对那些与阿片类药物注射吸毒作斗争的人产生了可怕的后果。 拟议的研究将制定和实施EBI的服务提供计划，该计划可在#年扩大规模 俄亥俄州农村以及美国其他农村地区正在经历阿片类药物流行。在UG3阶段，我们将使用 采用混合方法评估这一流行病的社会文化和政治背景 水平，包括机构、卫生保健和服务提供者以及三年内注射毒品的人(PWID) 阿巴拉契亚乡村的几个县。我们将使用受访者驱动抽样(RDS)来评估注射行为和 丙型肝炎病毒、艾滋病毒和性传播疾病的流行。在此多层次形成性数据的基础上，我们将确定服务差距并 与关键的社区利益相关者密切合作，围绕最相关的、 提供EBI的可行和可接受的实施战略，可能包括联盟建设、数据 跨县综合、众筹模式和远程医疗。在UH3阶段，我们将实施， 使用回归点位移监测和评估我们的阿片类药物注射器服务交付计划 设计并重复RDS调查。结果将包括服药过量死亡、NAS病例、丙型肝炎病毒和艾滋病毒检测 实施，并转介丙型肝炎病毒和艾滋病毒护理。执行结果将包括可接受性、采用率、 可行性、保真度、渗透率、可持续性和成本。将通过应用经验教训来评估可伸缩性 在UH3期间，在另外三个县的UG3阶段。 研究完成后，我们将在俄亥俄州的多个县和 开发了服务需求评估、社区参与决策的可输出模式，以及 实施。这种模式将适用于整个美国农村地区，在阿片类药物 已经发现上瘾，现有的服务提供有限或支离破碎。

PROJECT SUMMARY/ABSTRACT Ohio is experiencing one of the worst opioid injection epidemics in the country. The epidemic has severely affected rural Appalachian counties in southern Ohio, leading to a surge in overdose fatalities. Ohio’s heroin- related overdose rate is five times the national rate. In addition to overdose deaths, HCV has increased 400% between 2009-2013 and neonatal abstinence syndrome (NAS) has increased 9-fold between 2004-2014. Many evidence-based interventions (EBI), such as syringe service programs, medication-assisted treatment for substance use, naloxone provision for overdose treatment, and testing for HCV, HIV and sexually transmitted diseases (STD) are known to be effective in combating injection drug addiction and its consequences. Unfortunately, little is known about how to apply lessons learned in urban injection drug epidemics to sparsely- populated rural areas. In rural Ohio, as in much of the U.S., the delivery of EBI is limited or fragmented. A lack of coordination between key agencies to address overlap and gaps in services, especially in the context of severely constrained resources, has dire consequences for those struggling with opioid injection drug use. The proposed study will develop and implement a service delivery plan for EBI that can be scaled up in rural Ohio as well as other rural areas in the US experiencing opioid epidemics. In the UG3 phase, we will use a mixed methods approach to assess the socio-cultural and political context of the epidemic across multiple levels, including agencies, health care and service providers, and people who inject drugs (PWID) within three counties in rural Appalachia. We will use respondent-driven sampling (RDS) to assess injection behaviors and HCV, HIV, and STD prevalence. Building on this multi-level formative data, we will identify service gaps and work closely with key community stakeholders to build consensus around and prioritize the most relevant, feasible and acceptable implementation strategies to deliver EBI that may include coalition building, data synthesis across counties, crowdfunding models, and telemedicine. In the UH3 phase, we will implement, monitor and evaluate our service delivery plan for opioid injectors, using a regression point displacement design and repeat RDS surveys. Outcomes will include overdose deaths, NAS cases, HCV and HIV tests performed, and referral for HCV and HIV care. Implementation outcomes will include acceptability, adoption, feasibility, fidelity, penetration, sustainability, and cost. Scalability will be assessed by applying lessons learned in the UG3 phase in three additional counties during the UH3. Upon completion of the study, we will have enhanced EBI service delivery in multiple counties in Ohio and developed an exportable model of service needs assessment, community-engaged decision-making, and implementation. This model will be suitable for use throughout rural American in settings where opioid addiction has been identified and existing service delivery is limited or fragmented.