Promoting remote harm reduction and secondary services in rural settings (PROMOTE) study

项目总结 在过去的20年里，美国农村县的服药过量死亡率随着 与注射吸毒有关的丙型肝炎发病率上升和艾滋病毒暴发。农村阿片类药物危机是 发生并与不断演变的甲基苯丙胺使用和更广泛的多物质使用相互交织。负担 农村环境中与药物使用有关的发病率和死亡率因资源稀缺而加剧 如成瘾治疗、过量教育和纳洛酮分配、注射器交换和其他危害 减量服务(HRS)。鉴于甲基苯丙胺使用障碍缺乏生物医学治疗，努力 改善使用甲基苯丙胺的人的健康结果在很大程度上取决于减少危害的战略。在……里面 面对这场大流行，基层HRS组织面临着挑战，需要在 稀缺的资源和转变的吸毒行为。这项拟议的研究旨在了解药物使用的演变和 农村环境中的减害行为，包括多物质与甲基苯丙胺和 芬太尼很普遍，以便在这些社区内扩大有效的HRS。我们会 让HRS提供商和参与者参与调整战略，以便远程、非接触式交付 服务，并评估其实施情况。这项研究将探讨个人、人际关系和社区 根据社会生态模型对参与减少危害的影响。在目标1中，我们将评估 药物使用、减少伤害行为和关于减少伤害的参与和决策过程 在吸毒者中使用和分发用品(PWUD)。我们将通过多个渠道收集数据 方法包括基线调查、使用移动电话的两周每日评估和半结构化 对PWUD访问HRS的采访。在目标2中，使用社交网络调查方法以及深度 定性访谈，我们试图通过确定个人身份来了解二次分配的动态 以及可能实施网络干预的参与者拥护者的社交网络特征。在AIM 3、我们将制定和评估远程减少伤害服务交付的实施情况，包括数字 锁箱和邮购用品是为解决农村地区的结构性障碍而量身定做的。这一过程将 包括通过关键线人访谈、有指导的讨论小组形成学习来评估需求 由HRS提供商共同领导的社区，以及由EPIS实施提供信息的实施和评估 框架。这项工作将为制定实用的减少危害交付战略提供基础知识 针对农村地区在大流行时代提供服务方面面临的不同挑战，以及向未来网络提供信息 以甲基苯丙胺和普遍存在的合成毒品为特征的农村吸毒干预措施 阿片类药物。

PROJECT SUMMARY Over the past two decades, rural counties in the U.S. have seen increasing rates of overdose death along with rising hepatitis C incidence and outbreaks of HIV linked to injection drug use. The rural opioid crisis is co- occurring and intertwined with evolving methamphetamine use and polysubstance use more broadly. The burden of morbidity and mortality related to substance use in the rural setting is exacerbated by the scarcity of resources such as addiction treatment, overdose education and naloxone distribution, syringe exchange, and other harm reduction services (HRS). Given the lack of biomedical treatment for methamphetamine use disorder, efforts to improve health outcomes for people who use methamphetamine hinge largely on harm reduction strategies. In the face of the pandemic grassroots HRS organizations have been challenged to adapt service delivery amidst sparse resources and shifting drug use behavior. The proposed study aims to understand evolving drug use and harm reduction behavior in rural settings, including those where polysubstance use with methamphetamine and fentanyl are prevalent, in order to inform the expansion of effective HRS within these communities. We will engage HRS providers and participants in a process of tailoring strategies for remote, contactless delivery of services, and evaluate their implementation. This study will explore individual, interpersonal, and community influences on engagement in harm reduction according to the socio-ecological model. In Aim 1, we will assess drug use, harm reduction behavior, and decision-making processes regarding harm reduction engagement and use and distribution of supplies among people who use drugs (PWUD). We will collect data through multiple methods including baseline surveys, two weeks of daily assessments using mobile phones, and semi-structured interviews with PWUD accessing HRS. In Aim 2, using social network survey methods as well as in depth qualitative interviews, we seek to understand the dynamics of secondary distribution by identifying the personal and social network characteristics of participant champions who may implement network interventions. In Aim 3, we will develop and evaluate the implementation of remote harm reduction service delivery including digital lock boxes and mail ordered supplies tailored to address structural barriers in rural settings. This process will include needs assessment through key informant interviews, guided discussion groups forming a learning community co-led by an HRS provider, and implementation and evaluation informed by the EPIS implementation framework. This work will provide foundational knowledge to develop practical harm reduction delivery strategies for rural areas facing disparate challenges in pandemic-era service provision as well as inform future network interventions for rural drug use characterized by methamphetamine and the ubiquitous presence of synthetic opioids.