Mitigating the Outcomes Associated with the Injection Drug Use Epidemic in Southern Appalachia

北卡罗来纳州的急性丙型肝炎病毒（HCV）感染增加了228%，海洛因相关死亡增加 2010年至2015年期间为884%。北卡罗来纳州卫生和公共服务部（DHHS）进行了一次 脆弱性评估并确定了八个急性丙型肝炎病毒、慢性丙型肝炎病毒发病率高的西部农村县， 和阿片类药物过量致死RTI国际，北卡罗来纳大学查佩尔山分校，北卡罗来纳州卫生和公众服务部，当地卫生 各部门（LHD）和北卡罗来纳州减少伤害联盟正在合作应对RFA“艾滋病毒、丙型肝炎病毒 美国受阿片类注射药物流行影响的农村社区中的相关合并症 国家：建立预防、治疗和控制系统。我们的团队在NC的理想位置， 制定，实施和评估可持续的战略，以打击阿片类药物相关的不良后果， 农村注射毒品者（PWID）。UG 3/UH 3阶段项目的具体目标如下： UG3-1与PWID进行80次（每个县10次）半结构化访谈;开始使用 响应者驱动的采样（n=400）和LHD和注射器服务程序（SSP; n=200）;以及使用 基线自我报告数据和HCV和HIV检测结果，以描述HCV、HIV和 物质使用障碍UG3-2调查（邮件、电子和电话; n=150） 护理，紧急/紧急护理和行为卫生保健专业人员（HCP）在所有八个县，以评估 实践特征;对药物使用、HCV和HIV筛查指南的认识和遵守; 和态度的实施SSP，丙型肝炎护理，艾滋病毒护理跨实践设置。进行 与一部分利益相关者举行会议。UG3-3根据参与者的信息，确定为PWID提供服务的健康中心 在杰克逊县和海伍德县，随机执行命令， 治疗HCV、HIV和阿片类药物过量。评估基线和18年的知识和做法模式 培训后的几个月（由继续教育单位激励）将使我们能够衡量培训的影响。后 随着UG 3活动的成功完成，我们将在UH 3阶段实现以下目标：UH 3 -1。 完成PWID招募，进行6个月和12个月的随访访谈，以评估实质性变化 使用;性和注射风险行为; HCV和HIV检测;通过HCV和HIV护理的运动 级联;以及利用新的和扩大的服务，包括SSP和桥梁顾问。UH3-2部署 电子病历驱动的HCV、HIV和药物使用筛查; HCV的远程医疗支持， 艾滋病毒治疗;以及加强培训，以优化我们试点诊所的服务。以此为模板，我们将 招募、培训和优化2-3个额外的当地诊所，以扩大区域医疗服务。UH3-3使用后续行动 第5年的LHD和HCP调查、流行病学监测以及通过桥接与服务相关联的PWID数据 经过培训的咨询师和提供者，我们将评估对每个护理级联的影响，并将调查结果传播给 地方和国家合作伙伴。

Acute hepatitis C virus (HCV) infections in North Carolina increased 228% and heroin-related deaths increased 884% between 2010 and 2015. The NC Department of Health and Human Services (DHHS) conducted a vulnerability assessment and identified eight rural western counties with high rates of acute HCV, chronic HCV, and opioid overdose fatalities. RTI International, the University of NC at Chapel Hill, NC DHHS, local health departments (LHD), and the NC Harm Reduction Coalition are partnering in response to the RFA “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.” Our team is ideally positioned in NC to develop, implement, and evaluate sustainable strategies for combatting opioid-associated adverse outcomes in rural people who inject drugs (PWID). The specific aims of the project by UG3/UH3 phase are as follows: UG3–1. Conduct 80 (10 per county) semistructured interviews with PWID; begin recruiting PWID using respondent-driven sampling (n=400) and LHDs and syringe service programs (SSPs; n=200); and use baseline self-reported data and HCV and HIV testing results to describe the care cascade for HCV, HIV, and substance use disorders. UG3–2. Survey (mail, electronic and telephone; n=150) LHD personnel, primary care, emergency/urgent care, and behavioral health care professionals (HCPs) in all eight counties to assess practice characteristics; awareness of and adherence to substance use, HCV, and HIV screening guidelines; and attitudes regarding implementation of SSPs, HCV care, and HIV care across practice settings. Conduct meetings with a subset of stakeholders. UG3–3. Informed by participants, identify health centers serving PWID in Jackson and Haywood counties, randomize implementation order, and train providers on prevention and treatment of HCV, HIV, and opioid overdoses. Assessing knowledge and practice patterns at baseline and 18 months after training (incentivized with continuing education units) will allow us to gauge training impact. After successful completion of UG3 activities, we will pursue the following aims in the UH3 phase: UH3–1. Complete PWID recruitment, conduct 6- and 12-month follow-up interviews to assess changes in substance use; sexual and injection risk behaviors; HCV and HIV testing; movement through the HCV and HIV care cascade; and utilization of new and expanded services, including SSPs and bridge counselors. UH3–2. Deploy electronic medical record-driven screening for HCV, HIV, and substance use; telehealth support for HCV and HIV treatment; and booster training to optimize services in our pilot clinic(s). Using this as a template, we will recruit, train, and optimize 2–3 additional local clinics to expand regional care access. UH3–3. Using follow-up LHD and HCP surveys in Year 5, epidemiological surveillance, and data on PWID linked to services by bridge counselors and providers trained, we will assess the impact on each care cascade and disseminate findings to local and state partners.