Community-based, client-centered prevention homes to address the rural opioid epidemic

项目总结 受阿片类药物影响的农村社区对RFA-DA-17-014、艾滋病毒、丙型肝炎及相关合并症的反应 美国的注射毒品流行：建立预防、治疗和控制系统 (UG3/UH3)，我们提出了一项多阶段、混合方法的研究，旨在实施和评估一种新的 社区响应模式，我们将其命名为以社区为基础、以客户为中心的预防之家。 使用大型多站点注射器服务计划的组织基础设施，在地理上为 驱散威斯康星州北部农村社区的注射吸毒者，我们将建立 在当地建立响应系统，以促进为高风险客户提供循证预防服务。这个 以客户为中心的预防之家模式融合了预防病例管理和移动医疗 将信息技术融入传统的减少伤害服务中，在注射器服务计划中，我们 假设将增加使用预防服务。在UG3阶段，我们将执行需求评估 在威斯康星州的6个农村县与当地利益攸关方合作，并使用受访者驱动的抽样来 进行横断面流行病学评估，以估计艾滋病毒、病毒性肝炎和 性传播感染。视实现招聘和数据收集目标而定，在人类健康3 在项目阶段，我们将在3个县部署和评估以客户为中心的预防之家模式 对阿片类药物注射日益恶化的流行表现出最大的脆弱性。剩下的3个县不是 被选中实施的项目将作为量化评估项目效果的比较地点 在第五年。威斯康星州农村日益严重的阿片类药物注射问题非常严重，因为它 例证了在全国范围内观察到的趋势，表明对日益恶化的艾滋病毒、丙型肝炎和 循证预防服务严重不足的农村社区阿片类药物过量死亡 干预措施。这项建议具有很高的创新性，因为它将是第一项使用循证研究的研究 移动健康战略和加强预防协调的正式执行科学方法 注射器服务项目中的服务。它有可能产生很大的影响，因为我们的团队覆盖了全州， 广泛接触有风险的个人，并提供强大的基础设施，以执行严格的多站点评估 我们提议的模型。

PROJECT SUMMARY In response to RFA-DA-17-014, HIV, HCV and Related Comorbidities in Rural Communities Affected by Opioid Injection Drug Epidemics in the United States: Building Systems for Prevention, Treatment and Control (UG3/UH3), we propose a multi-phase, mixed-methods study that aims to implement and evaluate a novel community response model, which we have named the Community-Based, Client-Centered Prevention Home. Using the organizational infrastructure of a large, multi-site syringe service program serving a geographically disperse population of people who inject drugs in rural communities across Northern Wisconsin, we will build locally responsive systems to facilitate uptake of evidence-based prevention services for high-risk clients. The Client-Centered Prevention Home model incorporates prevention case management and mobile health information technology into traditional harm-reduction services delivered at syringe service programs, which we hypothesize will increase use prevention services. During the UG3 phase, we will perform needs assessments in 6 rural Wisconsin counties in partnership with local stakeholders, and use respondent driven sampling to conduct a cross-sectional epidemiologic evaluation to estimate the prevalence of HIV, viral hepatitis and sexually transmitted infections. Contingent upon meeting recruitment and data collection goals, in the UH3 phase of the project we will deploy and evaluate the Client-Centered Prevention Home model in the 3 counties demonstrating highest vulnerability to worsening epidemics of opioid injection. The 3 remaining counties not selected for implementation will serve as comparison sites in a quantitative evaluation of program effectiveness during year 5. The growing problem of opioid injection in rural Wisconsin is highly significant because it exemplifies trends observed nationally indicating severe vulnerability to worsening epidemics of HIV, HCV, and opioid overdose deaths in rural communities that are substantially underserved by evidence-based prevention interventions. This proposal is highly innovative because it will be the first study to use an evidence-based mHealth strategy and a formal implementation science approach to enhance coordination of prevention services in syringe service programs. It has potential for high impact because of our team's state-wide reach, broad access to at-risk individuals, and robust infrastructure for conducting a rigorous, multi-site evaluation of our proposed model.