Effect of structural interventions on substance use and HIV/HCV risk among rural PWUD

 描述（由申请人提供）：本次更新申请（R 01 DA 033862）的总体目标是确定结构性干预措施对阿巴拉契亚农村吸毒者参与风险降低和健康促进活动的影响。研究人员寻求继续进行的为期三年的R 01研究结果揭示了处方药滥用的不断变化的情况;这一流行病仍处于起步阶段。与许多农村和郊区不同，几乎没有证据表明过渡到海洛因滥用。在该队列中，从奥施康定（r）（缓释羟考酮）滥用到速释羟考酮滥用，最近又出现了含丁丙诺啡和加巴喷丁的产品滥用的明显转变。此外，丙型肝炎病毒的流行率和发病率很高，特别是考虑到阿巴拉契亚农村的人口密度。鉴于阿片类药物滥用和传染病传播的流行病，有两项结构性干预措施与农村吸毒人口特别相关 （PWUD）。医疗补助（MC）扩展（根据平价医疗法案[ACA]）和注射器获取计划（SAP）是两种结构性干预措施，可以增加PWUD之间的健康促进，但可能受到个人，网络和社区因素的严重影响。利用Latkin的动态社会系统模型，并利用现存的，非常成功的农村PWUD队列，目的包括：1）研究这些结构性干预措施的动态因素如何影响非法和处方药的纵向趋势 药物滥用; 2）确定这些结构性干预措施对艾滋病毒/丙型肝炎发病率和参与降低风险的影响; 3）评估这些结构性干预措施对接受药物滥用治疗的影响。这项研究是非常重要的，因为了解这些具体的结构性干预措施影响健康促进的机制是改善阿巴拉契亚农村公共卫生的关键。药物滥用和丙型肝炎病毒是两个最重要的，如果不是最重要的健康问题所面临的这一地区已经困扰着显着的健康差距。使用网络和地理空间风险的创新措施，以及联合分析和多级纵向统计模型，结果将不会 仅为制定干预措施提供信息，优化SAP和药物滥用治疗等风险降低服务的吸收和利用，但可能为进一步实施美国农村健康促进计划的政策提供信息。

 DESCRIPTION (provided by applicant): The overarching goal of this renewal application (R01DA033862) is to determine the influence of structural interventions on engagement in risk reduction and health promotion activities among rural Appalachian drug users. Results from the three-year R01 that the investigators seek to continue reveal an ever-changing landscape of prescription drug abuse; an epidemic that is still in its infancy. Unlike many rural and suburban areas, there is little evidence for the transition to heroin abuse. In this cohort, there has been marked shift from abuse of OxyContin(r) (extended-release oxycodone) to immediate release oxycodone to more recently, buprenorphine and gabapentin-containing products. In addition, rates of HCV prevalence and incidence are high, especially given the population density of rural Appalachia. Given the syndemic of opioid abuse and infectious disease transmission, two structural interventions are particularly relevant to this population of rural people who use drugs (PWUD). Medicaid (MC) expansion (under the Affordable Care Act [ACA]) and syringe access programs (SAP) are two structural interventions that may allow for increased engagement in health promotion among PWUD, but are likely heavily influenced by individual, network, and community-level factors. Utilizing Latkin's Dynamic Social Systems model and leveraging the extant, highly successful cohort of rural PWUD, the aims include: 1) examining how dynamic factors of these structural interventions influence longitudinal trends in illicit and prescription drug abuse; 2) determining the influence of these structural interventions on HIV/HCV incidence and engagement in risk reduction; and 3) assessing the influence of these structural interventions on uptake of substance abuse treatment. This study is highly significant given that understanding the mechanisms by which these specific structural interventions influence health promotion is key to improving public health in rural Appalachia. Substance abuse and HCV are two of the most important, if not the most important health issues facing this region already plagued with marked health disparities. Using innovative measures of network and geospatial risk, as well as conjoint analysis and multilevel longitudinal statistical models, results will not only inform development of interventions that optimize uptake and utilization of risk reduction services such as SAP and substance abuse treatment, but may inform policies surrounding further implementation of health promotion programs in the rural U.S.