Assessing Care in the Context of an HIV Outbreak among PWID in Appalachia

摘自家长奖 本更新申请(R01DA033862)的总体目标是确定结构的影响 阿巴拉契亚农村药物参与降低风险和促进健康活动的干预措施 用户。调查人员寻求继续进行的为期三年的R01的结果揭示了一个不断变化的 滥用处方药的情况；仍处于萌芽阶段的流行病。与许多农村和郊区不同 在这些地区，几乎没有证据表明向海洛因滥用过渡。在这群人中，有一个明显的转变 从滥用OxyContin®(缓释羟考酮)到立即释放羟考酮，再到最近， 丁丙诺啡和含加巴喷丁的产品。此外，丙型肝炎病毒的流行率和发病率为 很高，特别是考虑到阿巴拉契亚农村的人口密度。考虑到阿片类药物滥用的症状和 在传染病传播方面，有两种结构性干预措施与这一农村人口特别相关 吸毒者(PWUD)。扩大医疗补助(MC)(根据《平价医疗法案》[ACA])和注射器 准入计划(SAP)是两种结构性干预措施，可能会增加对健康的参与 在PWUD中的晋升，但很可能受到个人、网络和社区层面因素的严重影响。 利用拉特金的动态社会系统模型和利用现有的、非常成功的农村队列 PWUD，目的包括：1)检查这些结构性干预的动态因素如何影响 非法药物和处方药滥用的纵向趋势；2)确定这些结构性因素的影响 关于艾滋病毒/丙型肝炎发病率和参与降低风险的干预措施；以及3)评估这些干预措施的影响 对药物滥用治疗吸纳的结构性干预。这项研究具有非常重要的意义，因为 了解这些特定的结构性干预措施影响健康促进的机制 改善阿巴拉契亚农村公共卫生的关键。物质滥用和丙型肝炎病毒是最重要的两个问题，如果 这并不是该区域面临的最重要的健康问题，该区域已经受到明显的健康差距的困扰。vbl.使用 网络和地理空间风险的创新措施，以及联合分析和多层次纵向 统计模型、结果不仅将为优化吸收和利用的干预措施的发展提供信息 降低风险的服务，如SAP和药物滥用治疗，但可能会为以下政策提供信息 在美国农村地区进一步实施健康促进计划。

ABSTRACT FROM PARENT AWARD 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 a marked shift from abuse of OxyContin® (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.