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Tully DC, Power KA, Sarette J, Stopka TJ, Friedmann PD, Korthuis PT, Cooper H, Young AM, Seal DW, Westergaard RP, Allen TM. Validation of dried blood spots for capturing hepatitis C virus diversity for genomic surveillance. J Viral Hepat 2024; 31:266-270. [PMID: 38366329 PMCID: PMC11023755 DOI: 10.1111/jvh.13924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/14/2023] [Accepted: 01/17/2024] [Indexed: 02/18/2024]
Abstract
Dried blood spots (DBS) have emerged as a promising alternative to traditional venous blood for hepatitis C virus (HCV) testing. However, their capacity to accurately reflect the genetic diversity of HCV remains poorly understood. We employed deep sequencing and advanced phylogenetic analyses on paired plasma and DBS samples from two common subtypes to evaluate the suitability of DBS for genomic surveillance. Results demonstrated that DBS captured equivalent viral diversity compared to plasma with no phylogenetic discordance observed. The ability of DBS to accurately reflect the profile of viral genetic diversity suggests it may be a promising avenue for future surveillance efforts to curb HCV outbreaks.
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Affiliation(s)
- Damien C. Tully
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Center for Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Karen A. Power
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
| | - Jacklyn Sarette
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
| | - Thomas J. Stopka
- Tufts University School of Medicine, Department of Public Health and Community Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
| | - Peter D. Friedmann
- Baystate Medical Center—University of Massachusetts, Office of Research, UMass Chan Medical School - Baystate, 3601 Main Street, 3rd Floor, Springfield, MA, 01199, USA
| | - P. Todd Korthuis
- Oregon Health & Science University, 3270 Southwest Pavilion Loop OHSU Physicians Pavilion, Suite 350, Portland, OR, 97239, USA
| | - Hannah Cooper
- Rollins School of Public Health, Emory University, Grace Crum Rollins Building 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - April M. Young
- University of Kentucky, 760 Press Avenue Suite 280, Lexington, KY, 40536, USA
| | - David W. Seal
- Tulane University, School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2210, New Orleans, LA, 70112, USA
| | - Ryan P. Westergaard
- University of Wisconsin-Madison, 1685 Highland Avenue, 5th Floor, Madison, WI, 53705-2281, USA
| | - Todd M. Allen
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
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Rudolph AE, Nance RM, Bobashev G, Brook D, Akhtar W, Cook R, Cooper HL, Friedmann PD, Frost SDW, Go VF, Jenkins WD, Korthuis PT, Miller WC, Pho MT, Ruderman SA, Seal DW, Stopka TJ, Westergaard RP, Young AM, Zule WA, Tsui JI, Crane HM, Whitney BM, Delaney JAC. Evaluation of respondent-driven sampling in seven studies of people who use drugs from rural populations: findings from the Rural Opioid Initiative. BMC Med Res Methodol 2024; 24:94. [PMID: 38654219 PMCID: PMC11036624 DOI: 10.1186/s12874-024-02206-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/21/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Accurate prevalence estimates of drug use and its harms are important to characterize burden and develop interventions to reduce negative health outcomes and disparities. Lack of a sampling frame for marginalized/stigmatized populations, including persons who use drugs (PWUD) in rural settings, makes this challenging. Respondent-driven sampling (RDS) is frequently used to recruit PWUD. However, the validity of RDS-generated population-level prevalence estimates relies on assumptions that should be evaluated. METHODS RDS was used to recruit PWUD across seven Rural Opioid Initiative studies between 2018-2020. To evaluate RDS assumptions, we computed recruitment homophily and design effects, generated convergence and bottleneck plots, and tested for recruitment and degree differences. We compared sample proportions with three RDS-adjusted estimators (two variations of RDS-I and RDS-II) for five variables of interest (past 30-day use of heroin, fentanyl, and methamphetamine; past 6-month homelessness; and being positive for hepatitis C virus (HCV) antibody) using linear regression with robust confidence intervals. We compared regression estimates for the associations between HCV positive antibody status and (a) heroin use, (b) fentanyl use, and (c) age using RDS-1 and RDS-II probability weights and no weights using logistic and modified Poisson regression and random-effects meta-analyses. RESULTS Among 2,842 PWUD, median age was 34 years and 43% were female. Most participants (54%) reported opioids as their drug of choice, however regional differences were present (e.g., methamphetamine range: 4-52%). Many recruitment chains were not long enough to achieve sample equilibrium. Recruitment homophily was present for some variables. Differences with respect to recruitment and degree varied across studies. Prevalence estimates varied only slightly with different RDS weighting approaches, most confidence intervals overlapped. Variations in measures of association varied little based on weighting approach. CONCLUSIONS RDS was a useful recruitment tool for PWUD in rural settings. However, several violations of key RDS assumptions were observed which slightly impacts estimation of proportion although not associations.
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Affiliation(s)
- Abby E Rudolph
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, 1301 Cecil B Moore Avenue, Ritter Annex 905, Philadelphia, PA, USA
| | - Robin M Nance
- Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA
| | - Georgiy Bobashev
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Daniel Brook
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio, 43210, USA
| | - Wajiha Akhtar
- University of Wisconsin-Madison, Population Health Institute, 610 Walnut Street, 575 WARF, Madison, WI, 53726, USA
| | - Ryan Cook
- General Internal Medicine and Geriatrics, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239-3098, USA
| | - Hannah L Cooper
- Rollins School of Public Health, Emory University, Grace Crum Rollins Building, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
| | - Peter D Friedmann
- Baystate Medical Center-University of Massachusetts, Office of Research, UMass Chan Medical School - Baystate, 3601 Main Street, 3rd Floor, Springfield, MA, 01199, USA
| | - Simon D W Frost
- Microsoft Premonition, Microsoft Building 99, 14820 NE 36th St. Redmond, Seattle, WA, 98052, USA
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Vivian F Go
- University of North Carolina-Chapel Hill, 363 Rosenau Hall, CB# 7440, Chapel Hill, NC, 27599, USA
| | - Wiley D Jenkins
- Southern Illinois University, 201 E Madison Street, Springfield, IL, 62702, USA
| | - Philip T Korthuis
- Oregon Health & Science University, 3270 Southwest Pavilion Loop OHSU Physicians Pavilion, Suite 350, Portland, OR, 97239, USA
| | - William C Miller
- The Ohio State University, 302 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43210, USA
| | - Mai T Pho
- University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Stephanie A Ruderman
- Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA
| | - David W Seal
- Tulane University, 1440 Canal Street, Suite 2210, New Orleans, LA, 70112, USA
| | - Thomas J Stopka
- Tufts University School of Medicine, Public Health and Community Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
| | - Ryan P Westergaard
- University of Wisconsin-Madison, 1685 Highland Avenue, 5th Floor, Madison, WI, 53705-2281, USA
| | - April M Young
- University of Kentucky, 760 Press Avenue, Suite 280, Lexington, KY, 40536, USA
| | - William A Zule
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Judith I Tsui
- Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA
| | - Heidi M Crane
- Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA.
| | - Bridget M Whitney
- Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA
| | - Joseph A C Delaney
- Harborview Medical Center, University of Washington and University of Manitoba, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA
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Peddireddy SR, Livingston MD, Young AM, Freeman PR, Ibragimov U, Komro KA, Lofwall MR, Oser CB, Staton M, Cooper HLF. Willingness to utilize a mobile treatment unit in five counties at the epicenter of the US rural opioid epidemic. J Subst Use Addict Treat 2024; 159:209262. [PMID: 38103835 PMCID: PMC10947911 DOI: 10.1016/j.josat.2023.209262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/26/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION US federal policies are evolving to expand the provision of mobile treatment units (MTUs) offering medications for opioid use disorder (MOUD). Mobile MOUD services are critical for rural areas with poor geographic access to fixed-site treatment providers. This study explored willingness to utilize an MTU among a sample of people who use opioids in rural Eastern Kentucky counties at the epicenter of the US opioid epidemic. METHODS The study analyzed Cross-sectional survey data from the Kentucky Communities and Researchers Engaging to Halt the Opioid Epidemic (CARE2HOPE) study covering five rural counties in the state. Logistic regression models investigated the association between willingness to utilize an MTU providing buprenorphine and naltrexone and potential correlates of willingness, identified using the Behavioral Model for Vulnerable Populations. RESULTS The analytic sample comprised 174 people who used opioids within the past six months. Willingness to utilize an MTU was high; 76.5 % of participants endorsed being willing. Those who had recently received MOUD treatment, compared to those who had not received any form of treatment or recovery support services, had six-fold higher odds of willingness to use an MTU. However, odds of being willing to utilize an MTU were 73 % lower among those who were under community supervision (e.g., parole, probation) and 81 % lower among participants who experienced an overdose within the past six months. CONCLUSIONS There was high acceptability of MTUs offering buprenorphine and naltrexone within this sample, highlighting the potential for MTUs to alleviate opioid-related harms in underserved rural areas. However, the finding that people who were recently under community supervision or had overdosed were significantly less willing to seek mobile MOUD treatment suggest barriers (e.g., stigma) to mobile MOUD at individual and systemic levels, which may prevent improving opioid-related outcomes in these rural communities given their high rates of criminal-legal involvement and overdose.
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Affiliation(s)
- Snigdha R Peddireddy
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, USA.
| | - Melvin D Livingston
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, USA
| | - April M Young
- Department of Epidemiology and Environmental Health, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Patricia R Freeman
- Department of Pharmacy Practice & Science, University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Umedjon Ibragimov
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, USA
| | - Kelli A Komro
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, USA
| | - Michelle R Lofwall
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Carrie B Oser
- Department of Sociology, University of Kentucky College of Arts & Sciences, Lexington, KY, USA
| | - Michele Staton
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Hannah L F Cooper
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, USA
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Stopka TJ, Estadt AT, Leichtling G, Schleicher JC, Mixson LS, Bresett J, Romo E, Dowd P, Walters SM, Young AM, Zule W, Friedmann PD, Go VF, Baker R, Fredericksen RJ. Barriers to opioid use disorder treatment among people who use drugs in the rural United States: A qualitative, multi-site study. Soc Sci Med 2024; 346:116660. [PMID: 38484417 PMCID: PMC10997882 DOI: 10.1016/j.socscimed.2024.116660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/26/2023] [Accepted: 02/05/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND In 2020, 2.8 million people required substance use disorder (SUD) treatment in nonmetropolitan or 'rural' areas in the U.S. Among this population, only 10% received SUD treatment from a specialty facility, and 1 in 500 received medication for opioid use disorder (MOUD). We explored the context surrounding barriers to SUD treatment in the rural United States. METHODS We conducted semi-structured, in-depth interviews from 2018 to 2019 to assess barriers to SUD treatment among people who use drugs (PWUD) across seven rural U.S. study sites. Using the social-ecological model (SEM), we examined individual, interpersonal, organizational, community, and policy factors contributing to perceived barriers to SUD treatment. We employed deductive and inductive coding and analytical approaches to identify themes. We also calculated descriptive statistics for participant characteristics and salient themes. RESULTS Among 304 participants (55% male, mean age 36 years), we identified barriers to SUD treatment in rural areas across SEM levels. At the individual/interpersonal level, relevant themes included: fear of withdrawal, the need to "get things in order" before entering treatment, close-knit communities and limited confidentiality, networks and settings that perpetuated drug use, and stigma. Organizational-level barriers included: strict facility rules, treatment programs managed like corrections facilities, lack of gender-specific treatment programs, and concerns about jeopardizing employment. Community-level barriers included: limited availability of treatment in local rural communities, long distances and limited transportation, waitlists, and a lack of information about treatment options. Policy-level themes included insurance challenges and system-imposed barriers such as arrest and incarceration. CONCLUSION Our findings highlight multi-level barriers to SUD treatment in rural U.S. communities. Salient barriers included the need to travel long distances to treatment, challenges to confidentiality due to small, close-knit communities where people are highly familiar with one another, and high-threshold treatment program practices. Our findings point to the need to facilitate the elimination of treatment barriers at each level of the SEM in rural America.
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Affiliation(s)
- T J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
| | - A T Estadt
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | | | - J C Schleicher
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Medicine, Madison, WI, USA
| | - L S Mixson
- University of Washington, Department of Medicine, Seattle, WA, USA
| | - J Bresett
- Southern Illinois University at Carbondale, Dept of Public Health, Carbondale, IL, USA
| | - E Romo
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - P Dowd
- Chan Medical School-Baystate, University of Massachusetts, Springfield, MA, USA
| | - S M Walters
- New York University's Grossman School of Medicine, New York, NY, USA
| | - A M Young
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | - W Zule
- RTI International, Research Triangle, NC, USA
| | - P D Friedmann
- Chan Medical School-Baystate, University of Massachusetts, Springfield, MA, USA
| | - V F Go
- University, of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - R Baker
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - R J Fredericksen
- University of Washington, Department of Medicine, Seattle, WA, USA
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Havens JR, Lofwall MR, Young AM, Staton M, Schaninger T, Fraser H, Vickerman P, Walsh SL. Predictors of engagement in screening for a hepatitis C virus (HCV) treatment trial in a rural Appalachian community. J Viral Hepat 2024. [PMID: 38436098 DOI: 10.1111/jvh.13933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/29/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024]
Abstract
An HCV treatment trial was initiated in September 2019 to address the opioid/hepatitis C virus (HCV) syndemic in rural Kentucky. The focus of the current analysis is on participation in diagnostic screening for the trial. Initial eligibility (≥18 years of age, county resident) was established by phone followed by in-person HCV viremia testing. 900 rural residents met the inclusion criteria and comprised the analytic sample. Generalized linear models were specified to estimate the relative risk of non-attendance at the in-person visit determining HCV eligibility. Approximately one-quarter (22.1%) of scheduled participants were no-shows. People who inject drugs were no more likely than people not injecting drugs to be a no-show; however, participants ≤35 years of age were significantly less likely to attend. While the median time between phone screening and scheduled in-person screening was only 2 days, each additional day increased the odds of no-show by 3% (95% confidence interval: 2%-3%). Finally, unknown HCV status predicted no-show even after adjustment for age, gender, days between screenings and injection status. We found that drug injection did not predict no-show, further justifying expanded access to HCV treatment among people who inject drugs. Those 35 years and younger were more likely to no-show, suggesting that younger individuals may require targeted strategies for increasing testing and treatment uptake. Finally, streamlining the treatment cascade may also improve outcomes, as participants in the current study were more likely to attend if there were fewer days between phone screening and scheduled in-person screening.
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Affiliation(s)
- Jennifer R Havens
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Michelle R Lofwall
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - April M Young
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky, USA
| | - Michele Staton
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Takako Schaninger
- Division of Infectious Disease, Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Hannah Fraser
- Bristol Population Health Sciences Institute, Bristol Medical School, Bristol, UK
| | - Peter Vickerman
- Bristol Population Health Sciences Institute, Bristol Medical School, Bristol, UK
| | - Sharon L Walsh
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
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Pravosud V, Ballard AM, Holloway IW, Young AM. Latent Class Analysis of Online Platforms for Partner-Seeking and Sexual Behaviors Among Men Who Have Sex with Men from Central Kentucky. AIDS Behav 2024; 28:1015-1028. [PMID: 37824036 DOI: 10.1007/s10461-023-04210-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
Little is known whether engagement in sexual behaviors associated with potential HIV risks differs by subgroups of men who have sex with men (MSM), who are distinct regarding patterns of use of online tools for partner-seeking. Using latent class analysis, we revealed four classes of app-using MSM (n = 181, 18-34 y.o., 82.4% identified as White and non-Hispanic) residing in Central Kentucky: the Grindr/Tinder class; the Poly App Use class of MSM-oriented apps; the General Social Media class, and the Bumble class. Unadjusted penalized logistic regressions showed associations of the Poly App Use class with increased numbers of receptive anal sex partners and reporting condomless receptive anal sex. Adjusting for other covariates, poly app users versus others were more likely to be older (25-34 vs. 18-24, AOR = 3.81, 95%CI = 1.70-9.03), to report past six-month illicit drug use (AOR = 2.93, 95%CI = 1.25-7.43) and to have ever used pre-exposure prophylaxis (AOR = 2.79, 95%CI = 1.10-7.12). Poly app users had behavior profiles associated with an elevated HIV risk and also reported HIV-related protective behaviors likely indicating increased risk awareness among this class. Our findings warrant differentiation of behavior profiles by patterns of app use and suggest not to generalize sexual behaviors associated with potential HIV risks to all app-using MSM.
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Affiliation(s)
- Vira Pravosud
- Northern California Institute for Research and Education, University of California San Francisco, San Francisco VA Medical Center, San Francisco, CA, USA.
| | - April M Ballard
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Ian W Holloway
- Luskin School of Public Affairs, University of California Los Angeles, Los Angeles, CA, USA
| | - April M Young
- Department of Epidemiology and Environmental Health, University of Kentucky College of Public Health, Lexington, KY, USA
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
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Young AM, Havens JR, Cooper HLF, Fallin-Bennett A, Fanucchi L, Freeman PR, Knudsen H, Livingston MD, McCollister KE, Stone J, Vickerman P, Freeman E, Jahangir T, Larimore E, White CR, Cheatom C, Community Staff K, Design Team K. Kentucky Outreach Service Kiosk (KyOSK) Study protocol: a community-level, controlled quasi-experimental, type 1 hybrid effectiveness study to assess implementation, effectiveness and cost-effectiveness of a community-tailored harm reduction kiosk on HIV, HCV and overdose risk in rural Appalachia. BMJ Open 2024; 14:e083983. [PMID: 38431295 PMCID: PMC10910671 DOI: 10.1136/bmjopen-2024-083983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION Many rural communities bear a disproportionate share of drug-related harms. Innovative harm reduction service models, such as vending machines or kiosks, can expand access to services that reduce drug-related harms. However, few kiosks operate in the USA, and their implementation, impact and cost-effectiveness have not been adequately evaluated in rural settings. This paper describes the Kentucky Outreach Service Kiosk (KyOSK) Study protocol to test the effectiveness, implementation outcomes and cost-effectiveness of a community-tailored, harm reduction kiosk in reducing HIV, hepatitis C and overdose risk in rural Appalachia. METHODS AND ANALYSIS KyOSK is a community-level, controlled quasi-experimental, non-randomised trial. KyOSK involves two cohorts of people who use drugs, one in an intervention county (n=425) and one in a control county (n=325). People who are 18 years or older, are community-dwelling residents in the target counties and have used drugs to get high in the past 6 months are eligible. The trial compares the effectiveness of a fixed-site, staffed syringe service programme (standard of care) with the standard of care supplemented with a kiosk. The kiosk will contain various harm reduction supplies accessible to participants upon valid code entry, allowing dispensing data to be linked to participant survey data. The kiosk will include a call-back feature that allows participants to select needed services and receive linkage-to-care services from a peer recovery coach. The cohorts complete follow-up surveys every 6 months for 36 months (three preceding kiosk implementation and four post-implementation). The study will test the effectiveness of the kiosk on reducing risk behaviours associated with overdose, HIV and hepatitis C, as well as implementation outcomes and cost-effectiveness. ETHICS AND DISSEMINATION The University of Kentucky Institutional Review Board approved the protocol. Results will be disseminated in academic conferences and peer-reviewed journals, online and print media, and community meetings. TRIAL REGISTRATION NUMBER NCT05657106.
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Affiliation(s)
- April M Young
- Department of Epidemiology and Environmental Health, University of Kentucky, Lexington, Kentucky, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
| | - Jennifer R Havens
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Hannah L F Cooper
- Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | | | - Laura Fanucchi
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Patricia R Freeman
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
- Department of Pharmacy Practice and Science, University of Kentucky, Lexington, Kentucky, USA
| | - Hannah Knudsen
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Melvin D Livingston
- Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Kathryn E McCollister
- Division of Health Services Research and Policy, University of Miami, Coral Gables, Florida, USA
| | - Jack Stone
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Edward Freeman
- Department of Epidemiology and Environmental Health, University of Kentucky, Lexington, Kentucky, USA
| | - Tasfia Jahangir
- Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Elizabeth Larimore
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
| | - Carol R White
- Department of Epidemiology and Environmental Health, University of Kentucky, Lexington, Kentucky, USA
| | | | - KyOSK Community Staff
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
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Ibragimov U, Livingston MD, Young AM, Feinberg J, Korthuis PT, Akhtar WZ, Jenkins WD, Crane HM, Westergaard RP, Nance R, Miller WC, Bresett J, Khoury D, Hurt CB, Go VF, Nolte K, Cooper HLF. Correlates of Recent HIV Testing Among People Who Inject Drugs in Rural Areas: A Multi-site Cross-Sectional Study, 2018-2020. AIDS Behav 2024; 28:59-71. [PMID: 37515742 PMCID: PMC10823036 DOI: 10.1007/s10461-023-04140-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 07/31/2023]
Abstract
The Rural Opioid Initiative surveyed 2693 people who inject drugs (PWID) in eight rural U.S. areas in 2018-2020 about self-reported HIV testing in the past 6 months. Correlates of interest included receipt of any drug-related services, incarceration history, and structural barriers to care (e.g., lack of insurance, proximity to syringe service programs [SSP]). Overall, 20% of participants reported receiving an HIV test within the past 6 months. Multivariable generalized estimating equations showed that attending substance use disorder (SUD) treatment (OR 2.11, 95%CI [1.58, 2.82]), having health insurance (OR 1.42, 95%CI [1.01, 2.00]) and recent incarceration (OR 1.49, 95%CI [1.08, 2.04]) were positively associated with HIV testing, while experiencing a resource barrier to healthcare (inability to pay, lack of transportation, inconvenient hours, or lack of child care) had inverse (OR 0.73, 95%CI [0.56, 0.94]) association with HIV testing. We found that the prevalence of HIV testing among rural PWID is low, indicating an unmet need for testing. While SUD treatment or incarceration may increase chances for HIV testing for rural PWID, other avenues for expanding HIV testing, such as SSP, need to be explored.
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Affiliation(s)
- Umedjon Ibragimov
- BSHES Department of Emory University School of Public Health, Atlanta, GA, USA.
- Emory University, 1518 Clifton RD, GCR 558, Atlanta, GA, USA.
| | - Melvin D Livingston
- BSHES Department of Emory University School of Public Health, Atlanta, GA, USA
| | - April M Young
- Department of Epidemiology and Environmental Health, College of Public Health, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Judith Feinberg
- Departments of Behavioral Medicine & Psychiatry and Medicine/Infectious Diseases, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - P Todd Korthuis
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Wajiha Z Akhtar
- Population Health Institute, University of Wisconsin-Madison, Madison, WI, USA
| | - Wiley D Jenkins
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Carbondale, IL, USA
| | - Heidi M Crane
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ryan P Westergaard
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Robin Nance
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - William C Miller
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - John Bresett
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Carbondale, IL, USA
- Department of Public Health, Southern Illinois University at Carbondale, Carbondale, IL, USA
| | | | - Christopher B Hurt
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Vivian F Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kerry Nolte
- Department of Nursing, College of Health and Human Services, University of New Hampshire, Durham, NH, USA
| | - Hannah L F Cooper
- BSHES Department of Emory University School of Public Health, Atlanta, GA, USA
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9
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Saville CWN, Mann R, Lockard AS, Bark-Connell A, Gabuljah SG, Young AM, Thomas DR. Covid and the coalfield: Covid-19 vaccine hesitance in Wales and Appalachia. Soc Sci Med 2023; 337:116295. [PMID: 37857241 DOI: 10.1016/j.socscimed.2023.116295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 09/18/2023] [Accepted: 09/28/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Vaccine hesitancy is a barrier to Covid-19 vaccine uptake and displays a social gradient, compounding health disparities. While social gradients are a vital concept in health, they flatten distinctions between types of disadvantaged community. This paper focuses on vaccine hesitance in post-industrial and de-industrialising coalfields. The social consequences of the decline of coal mining may present barriers to vaccine uptake. METHODS We ran parallel surveys in Wales (N = 4187) and US states overlapping with central Appalachia (N = 4864), to examine whether vaccine attitudes and uptake varied between areas with different coal mining histories. These surveys were accompanied by qualitative interviews of 36 residents of these coalfields to explore vaccination decisions and triangulate with survey data. RESULTS Factor analysis identified four axes of attitudes in the survey data: vaccine confidence, covid scepticism, vaccine individualism, and concerned confusion. These themes were echoed in the interviews. Vaccine confidence was lower; and covid scepticism, vaccine individualism, and concerned confusion higher, in residents of areas of Wales with greater mining extent and where pits closed during certain periods. Residents of former US coal counties had lower vaccine confidence and higher covid scepticism, while those in current coal counties had greater vaccine individualism and concerned confusion. In former US coal counties and Welsh areas where pits closed since 1980, vaccine uptake was lower. Differences could not be explained by respondents' income and education. In the interviews, norms of social solidarity were often invoked by vaccinated respondents, while unvaccinated respondents did not frame decisions in the context of the industrial history of their areas. DISCUSSION The legacy of coal-mining's decline presents barriers to public health campaigns. We show evidence of this across two historically significant coalfields. Attention is needed to avert negative public health consequences of global energy transition.
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Affiliation(s)
| | - Robin Mann
- School of History, Law, and Social Sciences, Bangor University, Wales, UK
| | | | | | | | - April M Young
- College of Public Health, University of Kentucky, USA
| | - Daniel Rhys Thomas
- Communicable Disease Surveillance Centre, Public Health Wales, Wales, UK
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10
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Hoover DB, Korthuis PT, Waddell EN, Foot C, Conway C, Crane HM, Friedmann PD, Go VF, Nance RM, Pho MT, Satcher MF, Sibley A, Westergaard RP, Young AM, Cook R. Recent Incarceration, Substance Use, Overdose, and Service Use Among People Who Use Drugs in Rural Communities. JAMA Netw Open 2023; 6:e2342222. [PMID: 37943559 PMCID: PMC10636631 DOI: 10.1001/jamanetworkopen.2023.42222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/26/2023] [Indexed: 11/10/2023] Open
Abstract
Importance Drug use and incarceration have a substantial impact on rural communities, but factors associated with the incarceration of rural people who use drugs (PWUD) have not been thoroughly investigated. Objective To characterize associations between recent incarceration, overdose, and substance use disorder (SUD) treatment access among rural PWUD. Design, Setting, and Participants For this cross-sectional study, the Rural Opioid Initiative research consortium conducted a survey in geographically diverse rural counties with high rates of overdose across 10 US states (Illinois, Wisconsin, North Carolina, Oregon, Kentucky, West Virginia, Ohio, Massachusetts, New Hampshire, and Vermont) between January 25, 2018, and March 17, 2020, asking PWUD about their substance use, substance use treatment, and interactions with the criminal legal system. Participants were recruited through respondent-driven sampling in 8 rural US regions. Respondents who were willing to recruit additional respondents from their personal networks were enrolled at syringe service programs, community support organizations, and through direct community outreach; these so-called seed respondents then recruited others. Of 3044 respondents, 2935 included participants who resided in rural communities and reported past-30-day injection of any drug or use of opioids nonmedically via any route. Data were analyzed from February 8, 2022, to September 15, 2023. Exposure Recent incarceration was the exposure of interest, defined as a report of incarceration in jail or prison for at least 1 day in the past 6 months. Main Outcomes and Measures The associations between PWUD who were recently incarcerated and main outcomes of treatment use and overdose were examined using logistic regression. Results Of 2935 participants, 1662 (56.6%) were male, 2496 (85.0%) were White; the mean (SD) age was 36 (10) years; and in the past 30 days, 2507 (85.4%) reported opioid use and 1663 (56.7%) reported injecting drugs daily. A total of 1224 participants (41.7%) reported recent incarceration, with a median (IQR) incarceration of 15 (3-60) days in the past 6 months. Recent incarceration was associated with past-6-month overdose (adjusted odds ratio [AOR], 1.38; 95% CI, 1.12-1.70) and recent SUD treatment (AOR, 1.62; 95% CI, 1.36-1.93) but not recent medication for opioid use disorder (MOUD; AOR, 1.03; 95% CI, 0.82-1.28) or currently carrying naloxone (AOR, 1.02; 95% CI, 0.86-1.21). Conclusions and Relevance In this cross-sectional study of PWUD in rural areas, participants commonly experienced recent incarceration, which was not associated with MOUD, an effective and lifesaving treatment. The criminal legal system should implement effective SUD treatment in rural areas, including MOUD and provision of naloxone, to fully align with evidence-based SUD health care policies.
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Affiliation(s)
- Daniel B Hoover
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland
| | - P Todd Korthuis
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland
- Oregon Health & Science University-Portland State University School of Public Health, Portland
| | - Elizabeth Needham Waddell
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland
- Oregon Health & Science University-Portland State University School of Public Health, Portland
| | - Canyon Foot
- Division of General Internal Medicine, Oregon Health & Science University, Portland
| | | | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle
| | - Peter D Friedmann
- Office of Research, University of Massachusetts Chan Medical School-Baystate, Baystate Health, Springfield
| | - Vivian F Go
- Department of Health Behavior, University of North Carolina-Chapel Hill, Chapel Hill
| | - Robin M Nance
- Department of Medicine, University of Washington, Seattle
| | - Mai T Pho
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois
| | - Milan F Satcher
- Department of Community & Family Medicine, Dartmouth Health and Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Adams Sibley
- Department of Health Behavior, University of North Carolina-Chapel Hill, Chapel Hill
| | | | - April M Young
- College of Public Health, University of Kentucky, Lexington
| | - Ryan Cook
- Division of General Internal Medicine, Oregon Health & Science University, Portland
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11
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Upton EM, Rudolph AE, Ward PJ, Havens JR, Young AM. Corrigendum to "Extent and implications of omitted ties on network measures in a longitudinal social network survey of people who use drugs" [Drug Alcohol Depend. 238 (2022) 109554]. Drug Alcohol Depend 2023; 252:110901. [PMID: 37481411 PMCID: PMC10615686 DOI: 10.1016/j.drugalcdep.2023.110901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Affiliation(s)
- Elizabeth M Upton
- Department of Mathematics and Statistics, Williams College, Williamstown, MA, USA.
| | - Abby E Rudolph
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA
| | - Patrick J Ward
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA; Department of Biostatistics, UNC-Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer R Havens
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - April M Young
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA; Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
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12
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Ballard AM, Falk D, Greenwood H, Gugerty P, Feinberg J, Friedmann PD, Go VF, Jenkins WD, Korthuis PT, Miller WC, Pho MT, Seal DW, Smith GS, Stopka TJ, Westergaard RP, Zule WA, Young AM, Cooper HLF. Houselessness and syringe service program utilization among people who inject drugs in eight rural areas across the USA: a cross-sectional analysis. Harm Reduct J 2023; 20:157. [PMID: 37880724 PMCID: PMC10601138 DOI: 10.1186/s12954-023-00892-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Research conducted in urban areas has highlighted the impact of housing instability on people who inject drugs (PWID), revealing that it exacerbates vulnerability to drug-related harms and impedes syringe service program (SSP) use. However, few studies have explored the effects of houselessness on SSP use among rural PWID. This study examines the relationship between houselessness and SSP utilization among PWID in eight rural areas across 10 states. METHODS PWID were recruited using respondent-driven sampling for a cross-sectional survey that queried self-reported drug use and SSP utilization in the prior 30 days, houselessness in the prior 6 months and sociodemographic characteristics. Using binomial logistic regression, we examined the relationship between experiencing houselessness and any SSP use. To assess the relationship between houselessness and the frequency of SSP use, we conducted multinomial logistic regression analyses among participants reporting any past 30-day SSP use. RESULTS Among 2394 rural PWID, 56.5% had experienced houselessness in the prior 6 months, and 43.5% reported past 30-day SSP use. PWID who had experienced houselessness were more likely to report using an SSP compared to their housed counterparts (adjusted odds ratio [aOR] = 1.24 [95% confidence intervals [CI] 1.01, 1.52]). Among those who had used an SSP at least once (n = 972), those who experienced houselessness were just as likely to report SSP use two (aOR = 0.90 [95% CI 0.60, 1.36]) and three times (aOR = 1.18 [95% CI 0.77, 1.98]) compared to once. However, they were less likely to visit an SSP four or more times compared to once in the prior 30 days (aOR = 0.59 [95% CI 0.40, 0.85]). CONCLUSION This study provides evidence that rural PWID who experience houselessness utilize SSPs at similar or higher rates as their housed counterparts. However, housing instability may pose barriers to more frequent SSP use. These findings are significant as people who experience houselessness are at increased risk for drug-related harms and encounter additional challenges when attempting to access SSPs.
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Affiliation(s)
- April M Ballard
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA.
- School of Public Health, Georgia State University, 140 Decatur Street SE, Atlanta, GA, 30303, USA.
| | - Dylan Falk
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - Harris Greenwood
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - Paige Gugerty
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - Judith Feinberg
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Peter D Friedmann
- Office of Research, University of Massachusetts Chan Medical School-Baystate, Springfield, MA, USA
| | - Vivian F Go
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wiley D Jenkins
- School of Medicine, Southern Illinois University, Carbondale, IL, USA
| | - P Todd Korthuis
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - William C Miller
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Mai T Pho
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - David W Seal
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Gordon S Smith
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | | | - Ryan P Westergaard
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | | | - April M Young
- College of Public Health, University of Kentucky, 111 Washington Avenue, Lexington, KY, 40536, USA
| | - Hannah L F Cooper
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
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13
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Estadt AT, Miller WC, Kline D, Whitney BM, Young AM, Todd Korthuis P, Stopka TJ, Feinberg J, Zule WA, Pho MT, Friedmann PD, Westergaard RP, Eagen KV, Seaman A, Ma J, Go VF, Lancaster KE. Associations of hepatitis C virus (HCV) antibody positivity with opioid, stimulant, and polysubstance injection among people who inject drugs (PWID) in rural U.S. communities. International Journal of Drug Policy 2023:104222. [PMID: 37806839 PMCID: PMC10997735 DOI: 10.1016/j.drugpo.2023.104222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 09/18/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND People who inject drugs (PWID) in the rural U.S. often inject stimulants, alone or with opioids. The impact of these substance use patterns may influence HCV risk behaviors. This analysis examines the associations of HCV antibody positivity with injecting only opioids, only stimulants (methamphetamine/cocaine), and opioids and stimulants together among rural PWID. METHODS The Rural Opioid Initiative (ROI) consists of eight research sites that enrolled people who use drugs in rural communities in ten U.S. states from 2018 to 2020. This cross-sectional analysis included adult participants who resided in a study area and injected any drug in the past 30 days. The primary outcome was HCV antibody positivity. The exposure of interest was injection drug use classified as only opioids, only stimulants, separate injections of opioids and stimulants, and same-syringe injection of both in the past 30 days. We used multivariable log-binomial regression with generalized linear mixed models to generate prevalence ratios (P.R.) adjusted for demographics, injection history, health insurance, and substance use treatment. RESULTS Among 3,084 participants enrolled in the ROI, 1,982 met inclusion criteria. Most participants injected opioids and stimulants in the same syringe (34%) or separately (21%), followed by injecting only stimulants (26%), and injecting only opioids (19%). Half (51%) were HCV antibody positive. Compared to people who injected only stimulants, HCV antibody positivity was more prevalent among people who injected opioids alone (aPR=1.62, 95% CI:(1.29-2.03)), injected both opioids and stimulants separately (aPR=1.61, 95% CI:(1.32-1.95)), and in the same syringe (aPR=1.54, 95% CI:(1.28-1.85)). CONCLUSION HCV antibody positivity, indicating prior exposure, was highest among those who had recently injected opioids, alone or with stimulants. Additional nucleic acid testing is necessary to confirm active infection. More research is needed to determine the underlying causes of HCV antibody positivity by injection use.
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Affiliation(s)
- Angela T Estadt
- Ohio State University, College of Public Health, Division of Epidemiology, United States.
| | - William C Miller
- Ohio State University, College of Public Health, Division of Epidemiology, United States; Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - David Kline
- Wake Forest University School of Medicine, Division of Public Health Sciences, Department of Biostatistics and Data Science, United States
| | | | - April M Young
- University of Kentucky, Department of Epidemiology and Environmental Health, Center on Drug and Alcohol Research, United States
| | - P Todd Korthuis
- Oregon Health & Science University, Department of Medicine, Section of Addiction Medicine, United States
| | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, United States
| | - Judith Feinberg
- West Virginia University School of Medicine, Departments of Behavioral Medicine and Psychiatry and Medicine/Infectious Diseases, United States
| | - William A Zule
- RTI International, Research Triangle Park, NC, United States
| | - Mai T Pho
- University of Chicago, Department of Medicine, United States
| | - Peter D Friedmann
- University of Massachusetts Medical School-Baystate and Baystate Health, United States
| | - Ryan P Westergaard
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of Infectious Diseases, United States
| | - Kellene V Eagen
- University of Wisconsin - Madison, School of Medicine and Public Health, Department of Family Medicine and Community Health, United States
| | - Andrew Seaman
- Oregon Health & Science University, School of Medicine, United States
| | - Jimmy Ma
- University of Washington, Department of Medicine, Division of Allergy and Infectious Diseases, United States
| | - Vivian F Go
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Behavior, United States
| | - Kathryn E Lancaster
- Ohio State University, College of Public Health, Division of Epidemiology, United States; Division of Public Health Sciences, Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
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14
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Hetrick AT, Young AM, Elman MR, Bielavitz S, Alexander RL, Brown M, Waddell EN, Korthuis PT, Lancaster KE. Correction: A cross-sectional survey of potential factors, motivations, and barriers influencing research participation and retention among people who use drugs in the rural USA. Trials 2023; 24:618. [PMID: 37770936 PMCID: PMC10540352 DOI: 10.1186/s13063-023-07531-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Affiliation(s)
- Angela T Hetrick
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, USA.
| | - April M Young
- Department of Epidemiology, University of Kentucky, Lexington, USA
- Center On Drug and Alcohol Research, University of Kentucky, Lexington, USA
| | - Miriam R Elman
- Oregon Health & Science University-Portland State University School of Public Health, Portland, USA
| | - Sarann Bielavitz
- Oregon Health & Science University-Portland State University School of Public Health, Portland, USA
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, USA
| | | | - Morgan Brown
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, USA
| | - Elizabeth Needham Waddell
- Oregon Health & Science University-Portland State University School of Public Health, Portland, USA
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, USA
| | - P Todd Korthuis
- Oregon Health & Science University-Portland State University School of Public Health, Portland, USA
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, USA
| | - Kathryn E Lancaster
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, USA
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15
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Tsui JI, Whitney BM, Korthuis PT, Chan B, Pho MT, Jenkins WD, Young AM, Cooper HLF, Friedmann PD, Stopka TJ, de Gijsel D, Miller WC, Go VF, Westergaard R, Brown R, Seal DW, Zule WA, Feinberg J, Smith GS, Mixson LS, Fredericksen R, Crane HM, Delaney JA. Methamphetamine use and utilization of medications for opioid use disorder among rural people who use drugs. Drug Alcohol Depend 2023; 250:110911. [PMID: 37549545 PMCID: PMC10599300 DOI: 10.1016/j.drugalcdep.2023.110911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Methamphetamine use is common among persons with opioid use disorder. This study evaluated associations between methamphetamine use and treatment with agonist medications for opioid use disorder (MOUD, specifically buprenorphine, and/or methadone) in U.S. rural communities. METHODS The Rural Opioid Initiative (ROI) is a consortium spanning 10 states and 65 rural counties that included persons who reported past 30-day use of opioids and/or injection drug use between 1/2018 and 3/2020. Analyses were restricted to participants who had ever used opioids and had data on past 30-day methamphetamine use. Multivariable models examined the relationship between methamphetamine use and utilization of agonist MOUD. RESULTS Among 2899 participants, 2179 (75.2%) also reported recent methamphetamine use. Persons with methamphetamine use compared to those without were younger, more likely to have injected drugs, be unhoused, criminal justice involved, and less likely to have health insurance. Adjusted for age, sex, race, and study site, recent methamphetamine use was associated with lower relative odds of past 30-day methadone treatment (aOR=0.66; 95% CI: 0.45-0.99) and fewer methadone treatment days (aIRR=0.76; 0.57-0.99), but not past 30-day buprenorphine receipt (aOR=0.90; 0.67-1.20), buprenorphine treatment days in past 6 months: aIRR=0.88; 0.69-1.12) or perceived inability to access buprenorphine (aOR=1.12; 0.87-1.44) or methadone (aOR=1.06; 0.76-1.48). CONCLUSION Methamphetamine use is common among persons who use opioids in rural U.S. areas and negatively associated with current treatment and retention on methadone but not buprenorphine. Future studies should examine reasons for this disparity and reduce barriers to methadone for persons who use opioids and methamphetamine.
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Affiliation(s)
- Judith I Tsui
- Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195-6420, USA.
| | - Bridget M Whitney
- Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195-6420, USA
| | - P Todd Korthuis
- Department of Medicine, Oregon Health & Science University, 3270 Southwest Pavilion Loop OHSU Physicians Pavilion, Suite 350, Portland, OR 97239, USA
| | - Brian Chan
- Department of Medicine, Oregon Health & Science University, 3270 Southwest Pavilion Loop OHSU Physicians Pavilion, Suite 350, Portland, OR 97239, USA
| | - Mai T Pho
- University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Wiley D Jenkins
- Southern Illinois University School of Medicine, Springfield, IL 62794, USA
| | - April M Young
- University of Kentucky, 760 Press Avenue Suite 280, Lexington, KY 40536, USA
| | - Hannah L F Cooper
- Rollins School of Public Health, Emory University, Grace Crum Rollins Building 1518 Clifton Road, Atlanta, GA 30322, USA
| | - Peter D Friedmann
- Office of Research, UMass Chan Medical School - Baystate and Baystate Health, 3601 Main Street, 3rd Floor, Springfield, MA 01199, USA
| | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
| | - David de Gijsel
- Dartmouth-Hitchcock Medical Center, Section of Infectious Disease and International Health, Lebanon, NH, USA
| | - William C Miller
- The Ohio State University, 346 Cunz Hall 1841 Neil Ave, Columbus, OH 43210, USA
| | - Vivian F Go
- University of North Carolina-Chapel Hill, 363 Rosenau Hall CB# 7440, Chapel Hill, NC 27599, USA
| | - Ryan Westergaard
- University of Wisconsin-Madison, 1685 Highland Avenue, 5th Floor, Madison, WI 53705-2281, USA
| | - Randall Brown
- University of Wisconsin-Madison, 1685 Highland Avenue, 5th Floor, Madison, WI 53705-2281, USA
| | - David W Seal
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2210, New Orleans, LA 70112, USA
| | - William A Zule
- RTI International, 3040 E. Cornwallis Road, PO Box 12194, Research Triangle Park, NC 2709-2194, USA
| | - Judith Feinberg
- West Virginia University, 930 Chestnut Ridge Road, PO Box 9156, Morgantown, WV 26505, USA
| | - Gordon S Smith
- West Virginia University, 930 Chestnut Ridge Road, PO Box 9156, Morgantown, WV 26505, USA
| | - L Sarah Mixson
- Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195-6420, USA
| | - Rob Fredericksen
- Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195-6420, USA
| | - Heidi M Crane
- Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195-6420, USA
| | - Joseph A Delaney
- Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195-6420, USA
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16
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Tully DC, Power KA, Sarette J, Stopka TJ, Friedmann PD, Korthuis PT, Cooper H, Young AM, Seal DW, Westergaard RP, Allen TM. Validation of Dried Blood Spots for Capturing Hepatitis C Virus Diversity for Genomic Surveillance. medRxiv 2023:2023.07.06.23292160. [PMID: 37461565 PMCID: PMC10350139 DOI: 10.1101/2023.07.06.23292160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Dried blood spots (DBS) have emerged as a promising alternative to traditional venous blood for HCV testing. However, their capacity to accurately reflect the genetic diversity of HCV remains poorly understood. We employed deep sequencing and advanced phylogenetic analyses on paired plasma and DBS samples to evaluate the suitability of DBS for genomic surveillance. Results demonstrated that DBS captured equivalent viral diversity compared to plasma with no phylogenetic discordance observed. The ability of DBS to accurately reflect the profile of viral genetic diversity suggests it may be a promising avenue for future surveillance efforts to curb HCV outbreaks.
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Affiliation(s)
- Damien C. Tully
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Center for Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Karen A. Power
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
| | - Jacklyn Sarette
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
| | - Thomas J. Stopka
- Tufts University School of Medicine Public Health and Community Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
| | - Peter D. Friedmann
- Baystate Medical Center—University of Massachusetts, Office of Research, UMass Chan Medical School - Baystate, 3601 Main Street, 3rd Floor, Springfield, MA, 01199, USA
| | - P. Todd Korthuis
- Oregon Health & Science University, 3270 Southwest Pavilion Loop OHSU Physicians Pavilion, Suite 350, Portland, OR, 97239, USA
| | - Hannah Cooper
- Rollins School of Public Health, Emory University, Grace Crum Rollins Building 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - April M. Young
- University of Kentucky, 760 Press Avenue Suite 280, Lexington, KY, 40536, USA
| | - David W. Seal
- Tulane University, 1440 Canal Street, Suite 2210, New Orleans, LA, 70112, USA
| | - Ryan P. Westergaard
- University of Wisconsin-Madison, 1685 Highland Avenue, 5th Floor, Madison, WI, 53705-2281, USA
| | - Todd M. Allen
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
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Batty EJ, Ibragimov U, Fadanelli M, Gross S, Cooper K, Klein E, Ballard AM, Young AM, Lockard AS, Oser CB, Cooper HLF. A qualitative analysis of rural syringe service program fidelity in Appalachian Kentucky: Staff and participant perspectives. J Rural Health 2023; 39:328-337. [PMID: 36117151 PMCID: PMC10484119 DOI: 10.1111/jrh.12715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE As drug-related epidemics have expanded from cities to rural areas, syringe service programs (SSPs) and other harm reduction programs have been slow to follow. The recent implementation of SSPs in rural areas demands attention to program fidelity based on core components of SSP success. METHODS Semistructured interviews conducted with clients and staff at 5 SSPs in 5 counties within 2 Central Appalachian health districts. Interviews covered fidelity of SSP implementation to 6 core components: (1) meet needs for harm reduction supplies; (2) education and counseling for sexual, injection, and overdose risks; (3) cooperation between SSPs and local law enforcement; (4) provide other health and social services; (5) ensure low threshold access to services; and (6) promote dignity, the impact of poor fidelity on vulnerability to drug-related harms, and the risk environment's influence on program fidelity. We applied thematic methods to analyze the data. FINDINGS Rural SSPs were mostly faithful to the 6 core components. Deviations from core components can be attributed to certain characteristics of the local rural risk environment outlined in the risk environment model, including geographic remoteness, lack of resources and underdeveloped infrastructure, and stigma against people who inject drugs (PWID) CONCLUSIONS: As drug-related epidemics continue to expand outside cities, scaling up SSPs to serve rural PWID is essential. Future research should explore whether the risk environment features identified also influence SSP fidelity in other rural areas and develop and test strategies to strengthen core components in these vulnerable areas.
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Affiliation(s)
- E J Batty
- Department of Sociology, University of Kentucky, Lexington, Kentucky, USA
| | - U Ibragimov
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA
| | - M Fadanelli
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA
| | - S Gross
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - K Cooper
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA
| | - E Klein
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - A M Ballard
- Department of Environmental Health, Emory University, Atlanta, Georgia, USA
| | - A M Young
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA
| | - A S Lockard
- Kentucky River District Health Department, Hazard, Kentucky, USA
| | - C B Oser
- Department of Sociology, University of Kentucky, Lexington, Kentucky, USA
| | - H L F Cooper
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA
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18
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Ward PJ, Young AM, Slavova S, Liford M, Daniels L, Lucas R, Kavuluru R. Deep Neural Networks for Fine-Grained Surveillance of Overdose Mortality. Am J Epidemiol 2023; 192:257-266. [PMID: 36222700 DOI: 10.1093/aje/kwac180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/16/2022] [Accepted: 10/10/2022] [Indexed: 02/07/2023] Open
Abstract
Surveillance of drug overdose deaths relies on death certificates for identification of the substances that caused death. Drugs and drug classes can be identified through the International Classification of Diseases, Tenth Revision (ICD-10), codes present on death certificates. However, ICD-10 codes do not always provide high levels of specificity in drug identification. To achieve more fine-grained identification of substances on death certificate, the free-text cause-of-death section, completed by the medical certifier, must be analyzed. Current methods for analyzing free-text death certificates rely solely on lookup tables for identifying specific substances, which must be frequently updated and maintained. To improve identification of drugs on death certificates, a deep-learning named-entity recognition model was developed, utilizing data from the Kentucky Drug Overdose Fatality Surveillance System (2014-2019), which achieved an F1-score of 99.13%. This model can identify new drug misspellings and novel substances that are not present on current surveillance lookup tables, enhancing the surveillance of drug overdose deaths.
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19
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Levander XA, Foot CA, Magnusson SL, Cook RR, Ezell JM, Feinberg J, Go VF, Lancaster KE, Salisbury-Afshar E, Smith GS, Westergaard RP, Young AM, Tsui JI, Korthuis PT. Contraception and Healthcare Utilization by Reproductive-Age Women Who Use Drugs in Rural Communities: a Cross-Sectional Survey. J Gen Intern Med 2023; 38:98-106. [PMID: 35731368 PMCID: PMC9849531 DOI: 10.1007/s11606-022-07558-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/30/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Women who use drugs (WWUD) have low rates of contraceptive use and high rates of unintended pregnancy. Drug use is common among women in rural U.S. communities, with limited data on how they utilize reproductive, substance use disorder (SUD), and healthcare services. OBJECTIVE We determined contraceptive use prevalence among WWUD in rural communities then compared estimates to women from similar rural areas. We investigated characteristics of those using contraceptives, and associations between contraceptive use and SUD treatment, healthcare utilization, and substance use. DESIGN Rural Opioids Initiative (ROI) - cross-sectional survey using respondent-driven sampling (RDS) involving eight rural U.S. regions (January 2018-March 2020); National Survey on Family Growth (NSFG) - nationally-representative U.S. household reproductive health survey (2017-2019). PARTICIPANTS Women aged 18-49 with prior 30-day non-prescribed opioid and/or non-opioid injection drug use; fecundity determined by self-reported survey responses. MAIN MEASURES Unweighted and RDS-weighted prevalence estimates of medical/procedural contraceptive use; chi-squared tests and multi-level linear regressions to test associations. KEY RESULTS Of 855 women in the ROI, 36.8% (95% CI 33.7-40.1, unweighted) and 38.6% (95% CI 30.7-47.2, weighted) reported contraceptive use, compared to 66% of rural women in the NSFG sample. Among the ROI women, 27% had received prior 30-day SUD treatment via outpatient counseling or inpatient program and these women had increased odds of contraceptive use (aOR 1.50 [95% CI 1.08-2.06]). There was a positive association between contraception use and recent medications for opioid use disorder (aOR 1.34 [95% CI 0.95-1.88]) and prior 6-month primary care utilization (aOR 1.32 [95% CI 0.96-1.82]) that did not meet the threshold for statistical significance. CONCLUSION WWUD in rural areas reported low contraceptive use; those who recently received SUD treatment had greater odds of contraceptive use. Improvements are needed in expanding reproductive and preventive health within SUD treatment and primary care services in rural communities.
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Affiliation(s)
- Ximena A Levander
- Division of General Internal Medicine & Geriatrics, Addiction Medicine Section, Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
| | - Canyon A Foot
- Division of General Internal Medicine & Geriatrics, Addiction Medicine Section, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | - Ryan R Cook
- Division of General Internal Medicine & Geriatrics, Addiction Medicine Section, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Jerel M Ezell
- Africana Studies and Research Center, Cornell Center for Health Equity, Cornell University, Ithaca, NY, USA
| | - Judith Feinberg
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, USA
- Department of Medicine Section of Infectious Diseases, West Virginia University, Morgantown, WV, USA
| | - Vivian F Go
- Department of Health Behavior, School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Kathryn E Lancaster
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, USA
| | | | - Gordon S Smith
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Ryan P Westergaard
- Division of Infectious Diseases, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - April M Young
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Judith I Tsui
- Department of Medicine, Division of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - P Todd Korthuis
- Division of General Internal Medicine & Geriatrics, Addiction Medicine Section, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
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20
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Young AM, Brown JL, Hunt T, Sprague Martinez LS, Chandler R, Oga E, Winhusen TJ, Baker T, Battaglia T, Bowers-Sword R, Button A, Fallin-Bennett A, Fanucchi L, Freeman P, Glasgow LM, Gulley J, Kendell C, Lofwall M, Lyons MS, Quinn M, Rapkin BD, Surratt HL, Walsh SL. Protocol for community-driven selection of strategies to implement evidence-based practices to reduce opioid overdoses in the HEALing Communities Study: a trial to evaluate a community-engaged intervention in Kentucky, Massachusetts, New York and Ohio. BMJ Open 2022; 12:e059328. [PMID: 36123106 PMCID: PMC9486330 DOI: 10.1136/bmjopen-2021-059328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Opioid-involved overdose deaths continue to surge in many communities, despite numerous evidence-based practices (EBPs) that exist to prevent them. The HEALing Communities Study (HCS) was launched to develop and test an intervention (ie, Communities That HEAL (CTH)) that supports communities in expanding uptake of EBPs to reduce opioid-involved overdose deaths. This paper describes a protocol for a process foundational to the CTH intervention through which community coalitions select strategies to implement EBPs locally. METHODS AND ANALYSIS The CTH is being implemented in 67 communities (randomised to receive the intervention) in four states in partnership with coalitions (one per community). Coalitions must select at least five strategies, including one to implement each of the following EBPs: (a) overdose education and naloxone distribution; expanded (b) access to medications for opioid use disorder (MOUD), (c) linkage to MOUD, (d) retention in MOUD and (e) safer opioid prescribing/dispensing. Facilitated by decision aid tools, the community action planning process includes (1) data-driven goal setting, (2) discussion and prioritisation of EBP strategies, (3) selection of EBP strategies and (4) identification of next steps. Following review of epidemiologic data and information on existing local services, coalitions set goals and discuss, score and/or rank EBP strategies based on feasibility, appropriateness within the community context and potential impact on reducing opioid-involved overdose deaths with a focus on three key sectors (healthcare, behavioural health and criminal justice) and high-risk/vulnerable populations. Coalitions then select EBP strategies through consensus or majority vote and, subsequently, suggest or choose agencies with which to partner for implementation. ETHICS AND DISSEMINATION The HCS protocol was approved by a central Institutional Review Board (Advarra). Results of the action planning process will be disseminated in academic conferences and peer-reviewed journals, online and print media, and in meetings with community stakeholders. TRIAL REGISTRATION NUMBER NCT04111939.
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Affiliation(s)
- April M Young
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Jennifer L Brown
- Department of Psychological Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Timothy Hunt
- School of Social Work, Columbia University, New York, New York, USA
| | | | - Redonna Chandler
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA
| | - Emmanuel Oga
- Center for Applied Public Health Research, Research Triangle Institute, Research Triangle Park, North Carolina, USA
| | - T John Winhusen
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Trevor Baker
- General Internal Medicine-CARE Unit, Boston Medical Center, Boston, Massachusetts, USA
| | - Tracy Battaglia
- Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Rachel Bowers-Sword
- General Internal Medicine-CARE Unit, Boston Medical Center, Boston, Massachusetts, USA
| | - Amy Button
- Montefiore Hudson Valley Collaborative, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Laura Fanucchi
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Patricia Freeman
- College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
| | - LaShawn M Glasgow
- Community & Workplace Health, Research Triangle International, Research Triangle Park, North Carolina, USA
| | | | - Charles Kendell
- Franklin County Agency for Substance Abuse Policy Board, Frankfort, Kentucky, USA
| | - Michelle Lofwall
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Michael S Lyons
- Department of Emergency Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Maria Quinn
- Center for Behavioral Health, Holyoke Medical Center, Holyoke, Massachusetts, USA
| | - Bruce David Rapkin
- Epiemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Hilary L Surratt
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Sharon L Walsh
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
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21
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Upton EM, Rudolph AE, Ward PJ, Havens JR, Young AM. Extent and implications of omitted ties on network measures in a longitudinal social network survey of people who use drugs. Drug Alcohol Depend 2022; 238:109554. [PMID: 35850026 PMCID: PMC9514791 DOI: 10.1016/j.drugalcdep.2022.109554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/23/2022] [Accepted: 06/30/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous research has revealed under-reporting of personal network members (i.e., alters) in studies involving people who use drugs (PWUD). This analysis (1) characterizes relationships that were more likely to be omitted but later recalled with prompting and (2) identifies network structural characteristics most impacted by these omissions among a sample of PWUD in rural Appalachian Kentucky, an epicenter of the opioid epidemic. METHODS Data were collected through longitudinal assessments as part of the Social Networks Among Appalachian People (SNAP) study (2008-2017). Study participants completed interviewer-administered questionnaires that collected social network data via free-listing at baseline and six-month intervals. At visit 5, after free-listing, interviewers prompted participants with the names of previously reported alters. We used modified Poisson regression with generalized estimating equations to identify individual- and relationship-level characteristics associated with an alter being reported only after prompting. We examined the impact of including vs. excluding relationships reported after prompting on local and global sociometric network measures (i.e., betweenness centrality, bridging, density, mean degree, transitivity, cliques, and 2-cores). RESULTS Relationships reported only after prompting were more likely to be immediate family (Adjusted Prevalence Ratio [APR]:1.29; 95% Confidence Interval [CI]: 1.03-1.63) and less likely to involve sex (APR:0.54; 95% CI: 0.43-0.67). Considerable differences were observed for participant positional rankings of betweenness centrality and bridging, and differences in network density and average degree pre- and post-prompting were statistically significant. CONCLUSION Longitudinal network studies that aim to assess transmission dynamics, information diffusion, or peer influence should consider the effects of omitted relationships.
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Affiliation(s)
- Elizabeth M Upton
- Department of Mathematics and Statistics, Williams College, Williamstown, MA, USA.
| | - Abby E Rudolph
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA
| | - Patrick J Ward
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA; Department of Biostatistics, UNC-Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer R Havens
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - April M Young
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA; Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
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22
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Korthuis PT, Cook RR, Foot CA, Leichtling G, Tsui JI, Stopka TJ, Leahy J, Jenkins WD, Baker R, Chan B, Crane HM, Cooper HL, Feinberg J, Zule WA, Go VF, Estadt AT, Nance RM, Smith GS, Westergaard RP, Van Ham B, Brown R, Young AM. Association of Methamphetamine and Opioid Use With Nonfatal Overdose in Rural Communities. JAMA Netw Open 2022; 5:e2226544. [PMID: 35969400 PMCID: PMC9379740 DOI: 10.1001/jamanetworkopen.2022.26544] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/23/2022] [Indexed: 01/29/2023] Open
Abstract
Importance Overdoses continue to increase in the US, but the contribution of methamphetamine use is understudied in rural communities. Objective To estimate the prevalence of methamphetamine use and its correlates among people who use drugs (PWUD) in rural US communities and to determine whether methamphetamine use is associated with increased nonfatal overdoses. Design, Setting, and Participants From January 2018 through March 2020, the National Rural Opioid Initiative conducted cross-sectional surveys of PWUD in rural communities in 10 states (Illinois, Kentucky, New Hampshire, Massachusetts, North Carolina, Ohio, Oregon, Vermont, West Virginia, and Wisconsin). Participants included rural PWUD who reported any past-30-day injection drug use or noninjection opioid use to get high. A modified chain-referral sampling strategy identified seeds who referred others using drugs. Data analysis was performed from May 2021 to January 2022. Exposures Use of methamphetamine alone, opioids alone, or both. Main Outcomes and Measures Unweighted and weighted prevalence of methamphetamine use, any past-180-day nonfatal overdose, and number of lifetime nonfatal overdoses. Results Among the 3048 participants, 1737 (57%) were male, 2576 (85%) were White, and 225 (7.4%) were American Indian; the mean (SD) age was 36 (10) years. Most participants (1878 of 2970 participants with any opioid or methamphetamine use [63%]) reported co-use of methamphetamine and opioids, followed by opioids alone (702 participants [24%]), and methamphetamine alone (390 participants [13%]). The estimated unweighted prevalence of methamphetamine use was 80% (95% CI, 64%-90%), and the estimated weighted prevalence was 79% (95% CI, 57%-91%). Nonfatal overdose was greatest in people using both methamphetamine and opioids (395 of 2854 participants with nonmissing overdose data [22%]) vs opioids alone (99 participants [14%]) or methamphetamine alone (23 participants [6%]). Co-use of methamphetamine and opioids was associated with greater nonfatal overdose compared with opioid use alone (adjusted odds ratio, 1.45; 95% CI, 1.08-1.94; P = .01) and methamphetamine use alone (adjusted odds ratio, 3.26; 95% CI, 2.06-5.14; P < .001). Those with co-use had a mean (SD) of 2.4 (4.2) (median [IQR], 1 [0-3]) lifetime overdoses compared with 1.7 (3.5) (median [IQR], 0 [0-2]) among those using opioids alone (adjusted rate ratio, 1.20; 95% CI, 1.01-1.43; P = .04), and 1.1 (2.9) (median [IQR], 0 [0-1]) among those using methamphetamine alone (adjusted rate ratio, 1.81; 95% CI, 1.45-2.27; P < .001). Participants with co-use most often reported having tried and failed to access substance use treatment: 827 participants (44%) for both, 117 participants (30%) for methamphetamine alone, and 252 participants (36%) for opioids alone (χ22 = 33.8; P < .001). Only 66 participants (17%) using methamphetamine alone had naloxone. Conclusions and Relevance These findings suggest that harm reduction and substance use disorder treatment interventions must address both methamphetamine and opioids to decrease overdose in rural communities.
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Affiliation(s)
- P. Todd Korthuis
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Portland
- Oregon Health & Science University–Portland State University School of Public Health, Portland
| | - Ryan R. Cook
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Portland
| | - Canyon A. Foot
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Portland
| | | | - Judith I. Tsui
- Section of General Internal Medicine, Department of Medicine, University of Washington, Seattle
| | - Thomas J. Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | | | - Wiley D. Jenkins
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield
| | - Robin Baker
- Oregon Health & Science University–Portland State University School of Public Health, Portland
| | - Brian Chan
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Portland
| | - Heidi M. Crane
- Section of General Internal Medicine, Department of Medicine, University of Washington, Seattle
| | - Hannah L. Cooper
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Judith Feinberg
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown
- Department of Medicine, Infectious Diseases, West Virginia University School of Medicine, Morgantown
| | | | - Vivian F. Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina–Chapel Hill, Chapel Hill
| | - Angela T. Estadt
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus
| | - Robin M. Nance
- Section of General Internal Medicine, Department of Medicine, University of Washington, Seattle
| | - Gordon S. Smith
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown
| | - Ryan P. Westergaard
- Division of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - Brent Van Ham
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield
| | - Randall Brown
- Department of Family Medicine & Community Health, University of Wisconsin School of Medicine & Public Health, Madison
| | - April M. Young
- Department of Epidemiology, University of Kentucky, Lexington
- Center on Drug and Alcohol Research, University of Kentucky, Lexington
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23
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Jenkins RA, Whitney BM, Nance RM, Allen TM, Cooper HLF, Feinberg J, Fredericksen R, Friedmann PD, Go VF, Jenkins WD, Korthuis PT, Miller WC, Pho MT, Rudolph AE, Seal DW, Smith GS, Stopka TJ, Westergaard RP, Young AM, Zule WA, Delaney JAC, Tsui JI, Crane HM. The Rural Opioid Initiative Consortium description: providing evidence to Understand the Fourth Wave of the Opioid Crisis. Addict Sci Clin Pract 2022; 17:38. [PMID: 35883197 PMCID: PMC9321271 DOI: 10.1186/s13722-022-00322-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To characterize and address the opioid crisis disproportionately impacting rural U.S. regions. METHODS The Rural Opioid Initiative (ROI) is a two-phase project to collect and harmonize quantitative and qualitative data and develop tailored interventions to address rural opioid use. The baseline quantitative survey data from people who use drugs (PWUD) characterizes the current opioid epidemic (2018-2020) in eight geographically diverse regions. RESULTS Among 3,084 PWUD, 92% reported ever injecting drugs, 86% reported using opioids (most often heroin) and 74% reported using methamphetamine to get high in the past 30 days; 53% experienced homelessness in the prior 6 months; and 49% had ever overdosed. Syringe service program use varied by region and 53% had ever received an overdose kit or naloxone prescription. Less than half (48%) ever received medication for opioid use disorder (MOUD). CONCLUSIONS The ROI combines data across eight rural regions to better understand drug use including drivers and potential interventions in rural areas with limited resources. Baseline ROI data demonstrate extensive overlap between opioid and methamphetamine use, high homelessness rates, inadequate access to MOUD, and other unmet needs among PWUD in the rural U.S. By combining data across studies, the ROI provides much greater statistical power to address research questions and better understand the syndemic of infectious diseases and drug use in rural settings including unmet treatment needs.
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Affiliation(s)
- Richard A. Jenkins
- Prevention Research Branch, National Institute on Drug Abuse, 3WFN MSC 6024, 301 North Stonestreet Ave, Bethesda, MD 20892 USA
| | - Bridget M. Whitney
- University of Washington Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA 98106 USA
| | - Robin M. Nance
- University of Washington Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA 98106 USA
| | - Todd M. Allen
- Ragon Institute of MGH, MIT and Harvard, Rm 764 400 Technology Square, Cambridge, MA 02139 USA
| | - Hannah L. F. Cooper
- Rollins School of Public Health, Emory University, Grace Crum Rollins Building 1518 Clifton Road, Atlanta, GA 30322 USA
| | - Judith Feinberg
- West Virginia University, 930 Chestnut Ridge Road, PO Box 9156, Morgantown, WV 26505 USA
| | - Rob Fredericksen
- University of Washington Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA 98106 USA
| | - Peter D. Friedmann
- Baystate Medical Center—University of Massachusetts, Office of Research, UMass Chan Medical School - Baystate, 3601 Main Street, 3rd Floor, Springfield, MA 01199 USA
| | - Vivian F. Go
- University of North Carolina—Chapel Hill, 363 Rosenau Hall CB# 7440, Chapel Hill, NC 27599 USA
| | - Wiley D. Jenkins
- Southern Illinois University, 201 E Madison Street, Springfield, IL 62702 USA
| | - P. Todd Korthuis
- Oregon Health & Science University, 3270 Southwest Pavilion Loop OHSU Physicians Pavilion, Suite 350, Portland, OR 97239 USA
| | - William C. Miller
- The Ohio State University, 302 Cunz Hall 1841 Neil Ave, Columbus, OH 43210 USA
| | - Mai T. Pho
- University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637 USA
| | - Abby E. Rudolph
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, 1301 Cecil B Moore Avenue, Ritter Annex 905, Philadelphia, PA USA
| | - David W. Seal
- Tulane University, 1440 Canal Street, Suite 2210, New Orleans, LA 70112 USA
| | - Gordon S. Smith
- West Virginia University, 930 Chestnut Ridge Road, PO Box 9156, Morgantown, WV 26505 USA
- College of Pharmacy, University of Manitoba, Apotex Centre, 750 McDermot Ave. W, Winnipeg, MB R3E 0T5 Canada
| | - Thomas J. Stopka
- Tufts University School of Medicine Public Health and Community Medicine, 136 Harrison Avenue, Boston, MA 02111 USA
| | - Ryan P. Westergaard
- University of Wisconsin-Madison, 1685 Highland Avenue, 5th Floor, Madison, WI 53705-2281 USA
| | - April M. Young
- University of Kentucky, 760 Press Avenue Suite 280, Lexington, KY 40536 USA
| | - William A. Zule
- RTI International, 3040 E. Cornwallis Road, PO Box 12194, Research Triangle Park, NC 2709-2194 USA
| | - Joseph A. C. Delaney
- College of Pharmacy, University of Manitoba, Apotex Centre, 750 McDermot Ave. W, Winnipeg, MB R3E 0T5 Canada
| | - Judith I. Tsui
- University of Washington Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA 98106 USA
| | - Heidi M. Crane
- University of Washington Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA 98106 USA
| | - the Rural Opioid Initiative
- Prevention Research Branch, National Institute on Drug Abuse, 3WFN MSC 6024, 301 North Stonestreet Ave, Bethesda, MD 20892 USA
- University of Washington Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA 98106 USA
- Ragon Institute of MGH, MIT and Harvard, Rm 764 400 Technology Square, Cambridge, MA 02139 USA
- Rollins School of Public Health, Emory University, Grace Crum Rollins Building 1518 Clifton Road, Atlanta, GA 30322 USA
- West Virginia University, 930 Chestnut Ridge Road, PO Box 9156, Morgantown, WV 26505 USA
- Baystate Medical Center—University of Massachusetts, Office of Research, UMass Chan Medical School - Baystate, 3601 Main Street, 3rd Floor, Springfield, MA 01199 USA
- University of North Carolina—Chapel Hill, 363 Rosenau Hall CB# 7440, Chapel Hill, NC 27599 USA
- Southern Illinois University, 201 E Madison Street, Springfield, IL 62702 USA
- Oregon Health & Science University, 3270 Southwest Pavilion Loop OHSU Physicians Pavilion, Suite 350, Portland, OR 97239 USA
- The Ohio State University, 302 Cunz Hall 1841 Neil Ave, Columbus, OH 43210 USA
- University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637 USA
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, 1301 Cecil B Moore Avenue, Ritter Annex 905, Philadelphia, PA USA
- Tulane University, 1440 Canal Street, Suite 2210, New Orleans, LA 70112 USA
- Tufts University School of Medicine Public Health and Community Medicine, 136 Harrison Avenue, Boston, MA 02111 USA
- University of Wisconsin-Madison, 1685 Highland Avenue, 5th Floor, Madison, WI 53705-2281 USA
- University of Kentucky, 760 Press Avenue Suite 280, Lexington, KY 40536 USA
- RTI International, 3040 E. Cornwallis Road, PO Box 12194, Research Triangle Park, NC 2709-2194 USA
- College of Pharmacy, University of Manitoba, Apotex Centre, 750 McDermot Ave. W, Winnipeg, MB R3E 0T5 Canada
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Young AM, Lancaster KE, Bielavitz S, Elman MR, Cook RR, Leichtling G, Freeman E, Estadt AT, Brown M, Alexander R, Barrie C, Conn K, Elzaghal R, Maybrier L, McDowell R, Neal C, Lapidus J, Waddell EN, Korthuis PT. Peer-based Retention Of people who Use Drugs in Rural Research (PROUD-R 2): a multisite, randomised, 12-month trial to compare efficacy of standard versus peer-based approaches to retain rural people who use drugs in research. BMJ Open 2022; 12:e064400. [PMID: 35705346 PMCID: PMC9204453 DOI: 10.1136/bmjopen-2022-064400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 06/01/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Rural communities bear a disproportionate share of the opioid and methamphetamine use disorder epidemics. Yet, rural people who use drugs (PWUD) are rarely included in trials testing new drug use prevention and treatment strategies. Numerous barriers impede rural PWUD trial engagement and advancing research methods to better retain rural PWUD in clinical trials is needed. This paper describes the Peer-based Retention Of people who Use Drugs in Rural Research (PROUD-R2) study protocol to test the effectiveness of a peer-driven intervention to improve study retention among rural PWUD. METHODS AND ANALYSIS The PROUD-R2 study is being implemented in 21 rural counties in three states (Kentucky, Ohio and Oregon). People who are 18 years or older, reside in the study area and either used opioids or injected any drug to get high in the past 30 days are eligible for study inclusion. Participants are allocated in a 1:1 ratio to two arms, stratified by site to assure balance at each geographical location. The trial compares the effectiveness of two retention strategies. Participants randomised to the control arm provide detailed contact information and receive standard retention outreach by study staff (ie, contacts for locator information updates, appointment reminders). Participants randomised to the intervention arm are asked to recruit a 'study buddy' in addition to receiving standard retention outreach. Study buddies are invited to participate in a video training and instructed to remind their intervention participant of follow-up appointments and encourage retention. Assessments are completed by intervention, control and study buddy participants at 6 and 12 months after enrolment. ETHICS AND DISSEMINATION The protocol was approved by a central Institutional Review Board (University of Utah). Results of the study will be disseminated in academic conferences and peer-reviewed journals, online and print media, and in meetings with community stakeholders. TRIAL REGISTRATION NUMBER NCT03885024.
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Affiliation(s)
- April M Young
- Epidemiology, University of Kentucky, Lexington, Kentucky, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
| | - Kathryn E Lancaster
- Division of Epidemiology, Ohio State University College of Public Health, Columbus, Ohio, USA
| | | | - Miriam R Elman
- Oregon Health & Science University, Portland, Oregon, USA
| | - Ryan R Cook
- Oregon Health & Science University, Portland, Oregon, USA
| | | | - Edward Freeman
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA
| | | | | | - Rhonda Alexander
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA
| | - Caiti Barrie
- Oregon Health & Science University, Portland, Oregon, USA
| | - Kandi Conn
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA
| | - Rhody Elzaghal
- Oregon Health & Science University, Portland, Oregon, USA
| | - Lisa Maybrier
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA
| | | | - Cathy Neal
- The Ohio State University, Columbus, Ohio, USA
| | - Jodi Lapidus
- Oregon Health & Science University, Portland, Oregon, USA
| | - Elizabeth N Waddell
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
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Pravosud V, Ballard AM, Holloway IW, Young AM. Online Partner Seeking and Sexual Behaviors Among Men Who Have Sex With Men From Small and Midsized Towns: Cross-sectional Study. JMIR Form Res 2022; 6:e35056. [PMID: 35687395 PMCID: PMC9233248 DOI: 10.2196/35056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) residing outside of large urban areas are underrepresented in research on online partner seeking and sexual behaviors related to transmission of HIV. OBJECTIVE We aimed to determine associations between the use of the internet or social networking apps (online tools) to meet partners for sex, dating, or for both purposes (online partner seeking) and sexual behaviors among MSM residing in small and midsized towns in Kentucky, United States. METHODS Using peer-referral sampling and online self-administered questionnaires, data were collected from 252 men, aged 18 to 34 years, who had recently (past 6 months) engaged in anal sex with another man and resided in Central Kentucky. Using multivariable logistic regression models, we assessed associations of online partner seeking and HIV-related sexual behaviors. RESULTS Most (181/252, 71.8%) of the participants reported using online tools for partner seeking. Of these 181 respondents, 166 (91.7%) had used online tools to meet partners for sex (n=45, 27.1% for sex only; and n=121, 72.9% for sex and dating) and 136 (75.1%) had used online tools to meet partners for dating (n=15, 11% for dating only; and n=121, 89% for sex and dating). Adjusted analyses revealed that MSM who had engaged in condomless insertive and receptive anal intercourse were less likely to report online partner seeking (adjusted odds ratio [aOR] 0.22, 95% CI 0.07-0.68; P=.009 and aOR 0.25, 95% CI 0.10-0.66; P=.005, respectively). Increased number of insertive and receptive anal sex partners and substance use before or during sex were associated with higher odds of online partner seeking (aOR 1.31, 95% CI 1.11-1.55; P=.001; aOR 1.20, 95% CI 1.05-1.39; P=.008; and aOR 2.50, 95% CI 1.41-4.44; P=.002, respectively). CONCLUSIONS Among MSM who reside outside of large urban areas and practice online partner seeking, HIV risk-reduction interventions should address safer sex practices, including the risks for HIV transmission associated with alcohol or drug use before or during sex. MSM who do not practice online partner seeking are in need of continued outreach to reduce condomless anal sex.
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Affiliation(s)
- Vira Pravosud
- Center for Tobacco Control Research and Education, Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, United States
| | - April M Ballard
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Ian W Holloway
- Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, United States
| | - April M Young
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, United States
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, United States
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26
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Affiliation(s)
- Hannah L F Cooper
- Hannah L. F. Cooper and David H. Cloud are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Laura C. Fanucchi, Michelle Lofwall, and April M. Young are with the Center on Drug and Alcohol Research, University of Kentucky, Lexington. Laura C. Fanucchi is also with the Department of Medicine, University of Kentucky College of Medicine, Lexington. Michelle Lofwall is also with the Department of Behavioral Science, University of Kentucky College of Medicine, Lexington. April M. Young is also with the Department of Epidemiology, University of Kentucky College of Public Health, Lexington
| | - David H Cloud
- Hannah L. F. Cooper and David H. Cloud are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Laura C. Fanucchi, Michelle Lofwall, and April M. Young are with the Center on Drug and Alcohol Research, University of Kentucky, Lexington. Laura C. Fanucchi is also with the Department of Medicine, University of Kentucky College of Medicine, Lexington. Michelle Lofwall is also with the Department of Behavioral Science, University of Kentucky College of Medicine, Lexington. April M. Young is also with the Department of Epidemiology, University of Kentucky College of Public Health, Lexington
| | - Laura C Fanucchi
- Hannah L. F. Cooper and David H. Cloud are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Laura C. Fanucchi, Michelle Lofwall, and April M. Young are with the Center on Drug and Alcohol Research, University of Kentucky, Lexington. Laura C. Fanucchi is also with the Department of Medicine, University of Kentucky College of Medicine, Lexington. Michelle Lofwall is also with the Department of Behavioral Science, University of Kentucky College of Medicine, Lexington. April M. Young is also with the Department of Epidemiology, University of Kentucky College of Public Health, Lexington
| | - Michelle Lofwall
- Hannah L. F. Cooper and David H. Cloud are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Laura C. Fanucchi, Michelle Lofwall, and April M. Young are with the Center on Drug and Alcohol Research, University of Kentucky, Lexington. Laura C. Fanucchi is also with the Department of Medicine, University of Kentucky College of Medicine, Lexington. Michelle Lofwall is also with the Department of Behavioral Science, University of Kentucky College of Medicine, Lexington. April M. Young is also with the Department of Epidemiology, University of Kentucky College of Public Health, Lexington
| | - April M Young
- Hannah L. F. Cooper and David H. Cloud are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Laura C. Fanucchi, Michelle Lofwall, and April M. Young are with the Center on Drug and Alcohol Research, University of Kentucky, Lexington. Laura C. Fanucchi is also with the Department of Medicine, University of Kentucky College of Medicine, Lexington. Michelle Lofwall is also with the Department of Behavioral Science, University of Kentucky College of Medicine, Lexington. April M. Young is also with the Department of Epidemiology, University of Kentucky College of Public Health, Lexington
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Fadanelli M, Cooper HLF, Freeman PR, Ballard AM, Ibragimov U, Young AM. A qualitative study on pharmacy policies toward over-the-counter syringe sales in a rural epicenter of US drug-related epidemics. Harm Reduct J 2022; 19:1. [PMID: 34996466 PMCID: PMC8742380 DOI: 10.1186/s12954-021-00569-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Expanding access to sterile syringes in rural areas is vital, as injection-related epidemics expand beyond metropolitan areas globally. While pharmacies have potential to be an easily accessible source of sterile syringes, research in cities has identified moral, legal and ethical barriers that preclude over-the-counter (OTC) sales to people who inject drugs (PWID). The current study builds on prior urban-based research by elucidating (1) pharmacy OTC policies and (2) pharmacists’ rationale for, and barriers and facilitators to, OTC syringe sales in a US rural area hard hit by drug-related epidemics. Methods We conducted 14 semi-structured interviews with pharmacists recruited from two Eastern Kentucky health districts. Interview domains included experiences with, and attitudes toward, selling OTC syringes to PWID. Constructivist grounded theory methods were used to analyze verbatim transcripts. Results Most pharmacists operated “restrictive OTC” pharmacies (n = 8), where patients were required to have a prescription or proof of medical need to purchase a syringe. The remainder (n = 6) operated “open OTC” pharmacies, which allowed OTC syringe sales to most patients. Both groups believed their pharmacy policies protected their community and pharmacy from further drug-related harm, but diverging policies emerged because of stigma toward PWID, perceptions of Kentucky law, and belief OTC syringe sales were harmful rather than protective to the community. Conclusion Our results suggest that restrictive OTC pharmacy policies are rooted in stigmatizing views of PWID. Anti-stigma education about substance use disorder (SUD), human immunodeficiency virus (HIV), and Hepatitis C (HCV) is likely needed to truly shift restrictive pharmacy policy.
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Affiliation(s)
- Monica Fadanelli
- Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
| | - Hannah L F Cooper
- Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | | | - April M Ballard
- Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | - Umed Ibragimov
- Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | - April M Young
- University of Kentucky College of Public Health, Lexington, KY, USA
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Hetrick AT, Young AM, Elman MR, Bielavitz S, Alexander RL, Brown M, Waddell EN, Korthuis PT, Lancaster KE. A cross-sectional survey of potential factors, motivations, and barriers influencing research participation and retention among people who use drugs in the rural USA. Trials 2021; 22:948. [PMID: 34930410 PMCID: PMC8690874 DOI: 10.1186/s13063-021-05919-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Despite high morbidity and mortality among people who use drugs (PWUD) in rural America, most research is conducted within urban areas. Our objective was to describe influencing factors, motivations, and barriers to research participation and retention among rural PWUD. METHODS We recruited 255 eligible participants from community outreach and community-based, epidemiologic research cohorts from April to July 2019 to participate in a cross-sectional survey. Eligible participants reported opioid or injection drug use to get high within 30 days and resided in high-needs rural counties in Oregon, Kentucky, and Ohio. We aggregated response rankings to identify salient influences, motivations, and barriers. We estimated prevalence ratios to assess for gender, preferred drug use, and geographic differences using log-binomial models. RESULTS Most participants were male (55%) and preferred methamphetamine (36%) over heroin (35%). Participants reported confidentiality, amount of financial compensation, and time required as primary influential factors for research participation. Primary motivations for participation include financial compensation, free HIV/HCV testing, and contribution to research. Changed or false participant contact information and transportation are principal barriers to retention. Respondents who prefer methamphetamines over heroin reported being influenced by the purpose and use of their information (PR = 1.12; 95% CI: 1.00, 1.26). Females and Oregonians (versus Appalachians) reported knowing and wanting to help the research team as participation motivation (PR = 1.57; 95% CI: 1.09, 2.26 and PR = 2.12; 95% CI: 1.51, 2.99). CONCLUSIONS Beyond financial compensation, researchers should emphasize confidentiality, offer testing and linkage with care, use several contact methods, aid transportation, and accommodate demographic differences to improve research participation and retention among rural PWUD.
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Affiliation(s)
- Angela T Hetrick
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, USA.
| | - April M Young
- Department of Epidemiology, University of Kentucky, Lexington, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, USA
| | - Miriam R Elman
- Oregon Health & Science University-Portland State University School of Public Health, Portland, USA
| | - Sarann Bielavitz
- Oregon Health & Science University-Portland State University School of Public Health, Portland, USA
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, USA
| | | | - Morgan Brown
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, USA
| | - Elizabeth Needham Waddell
- Oregon Health & Science University-Portland State University School of Public Health, Portland, USA
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, USA
| | - P Todd Korthuis
- Oregon Health & Science University-Portland State University School of Public Health, Portland, USA
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, USA
| | - Kathryn E Lancaster
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, USA
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Rudolph AE, Young AM. Privacy and Confidentiality Considerations for Collecting HIV Risk Network Data among Men who Have Sex with Men and Implications for Constructing Valid Risk Networks. Soc Networks 2021; 67:47-54. [PMID: 34712004 PMCID: PMC8547314 DOI: 10.1016/j.socnet.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Studies aiming to construct risk networks have historically collected network members' names, demographic characteristics and relational data (i.e., type, strength, duration, frequency of interaction, and HIV-related risk behaviors between the pair). Due to difficulties in constructing risk networks stemming from partner anonymity and the use of nicknames, some studies also collect network members' screen names, phone numbers, physical attributes, and scars/tattoos to assist with entity resolution. In-depth interviews with 20 men who have sex with men and transgender women in Kentucky assessed privacy/confidentiality concerns as well as accuracy/recall issues associated with providing these details. Most preferred providing alters' nicknames/first names only or a first name with the first letter of the last name. Many perceived screen names, phone numbers, and scars/tattoos to be too personal/identifying. Willingness to provide more detailed information varied by relationship type/strength, which could influence the validity of the resulting network.
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Affiliation(s)
- Abby E. Rudolph
- Department of Epidemiology, Boston University School of Public Health, Boston MA
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia PA
| | - April M. Young
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington KY
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington KY
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Kumar S, Goburdhun R, Corbett ML, Patel PH, Groves C, Chow J, Young AM, Uren S, Chaudry MA, Kumar S. Minimally Invasive Surgical Approach for Esophageal Adenocarcinoma in a Patient with Previous Belsey Mark IV Fundoplication: A Case Report. Surg Case Rep 2021. [DOI: 10.31487/j.scr.2021.09.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Historically, the management for recurrent or persistent Gastro-esophageal reflux disease included selective vagotomy and fundoplication. Despite these surgical interventions, the risk of Barrett’s esophagus (BE) and subsequent malignant transformation remains, requiring cancer resection surgery. We present a case of a patient with a gastro-esophageal junction (GEJ) adenocarcinoma, who underwent a pediatric thoracotomy and Belsey Mark IV fundoplication, and was successfully treated by Laparoscopic Ivor-Lewis Esophagectomy (LILE).
Case Presentation: This 64-year-old gentleman with BE and GEJ adenocarcinoma was previously deemed unsuitable for curative surgery due to clinical staging indicating a tumor length of 10cm and suspected invasion of the left pleura. Further staging by Endoscopic ultrasound indicated no evidence of pleural invasion with the distal esophageal thickening in keeping with his previous Belsey Mark IV fundoplication. He underwent neo-adjuvant chemotherapy and a subsequent LILE with complete laparoscopic reversion of the gastric fundoplication without injury to the gastroepiploic artery or fundus. There was sufficient preservation of conduit length to enable a tension free hand-sewn anastomosis with an uneventful post-operative recovery. Final histopathology confirmed ypT1 ypN0 moderately differentiated adenocarcinoma with R0 resection margins. The patient has completed 24 months of cancer recurrence free surveillance.
Conclusion: We describe the successful management of a patient by LILE on a background of previous hiatal fundoplication surgery, previously refused curative surgery. We highlight the importance of EUS as a staging modality for such cases showing invasive disease to increase the final clinical staging accuracy. We suggest a minimally invasive approach may be utilized for successful re-do hiatal dissection as an alternative to a conventional open surgery.
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Havens JR, Schaninger T, Fraser H, Lofwall M, Staton M, Young AM, Hoven A, Walsh SL, Vickerman P. Eliminating hepatitis C in a rural Appalachian county: protocol for the Kentucky Viral Hepatitis Treatment Study (KeY Treat), a phase IV, single-arm, open-label trial of sofosbuvir/velpatasvir for the treatment of hepatitis C. BMJ Open 2021; 11:e041490. [PMID: 34226208 PMCID: PMC8258565 DOI: 10.1136/bmjopen-2020-041490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The overall goal of the Kentucky Viral Hepatitis Treatment Study (KeY Treat) is to eliminate hepatitis C transmission from a county in Appalachian Kentucky by removing the barriers to accessing hepatitis C virus (HCV) treatment. METHODS/ANALYSIS KeY Treat is a phase IV, open-label, single-arm clinical trial of sofosbuvir/velpatasvir (SOF/VEL) for the treatment of viraemic HCV infections. Those eligible for KeY Treat are at least 18 years of age, viraemic and are residents of the target county. Pregnant women are not eligible. Rapid HCV RNA screening is used to determine eligibility, and those with a quantifiable viral load (VL) consenting to participate initiate SOF/VEL on the same day. All pharmacologic treatment and related medical care is provided free of charge using a non-specialist provider model. Follow-up visits occur at 2, 6 and 12 weeks during treatment to assess medication adherence (measured via VL and self-report), side effects and engagement in risk behaviours. Post-treatment visits occur at 12 weeks (sustained virologic response (SVR12) visit), 6 months and 12 months post-treatment completion to assess re-infection. A control county has also been identified, and prevalence and incidence of chronic HCV infections will be compared with the target community longitudinally. The primary outcome to assess elimination is SVR12. However, several outcomes will be measured to assess the effectiveness of removing the barriers to HCV treatment, including treatment entry, completion and re-infection. Analyses will be conducted via a generalised linear model framework that can incorporate flexible covariate adjustment and multiple outcome types with a compatible link function. Mathematical modelling will be completed assessing the impact and cost-effectiveness of the intervention. ETHICS AND DISSEMINATION KeY Treat has been approved by the Institutional Review Board at the University of Kentucky. Results from KeY Treat will be presented at conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03949764.
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Affiliation(s)
- Jennifer R Havens
- Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Takako Schaninger
- Infectious Diseases, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Hannah Fraser
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Michelle Lofwall
- Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Michele Staton
- Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - April M Young
- Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky, USA
| | - Ardis Hoven
- Infectious Diseases, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Sharon L Walsh
- Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
- London School of Hygiene & Tropical Medicine, London, UK
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Young AM, Livingston M, Vickers-Smith R, Cooper HLF. Emergence of wasp dope in rural Appalachian Kentucky. Addiction 2021; 116:1901-1907. [PMID: 33063438 PMCID: PMC8046840 DOI: 10.1111/add.15291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/28/2020] [Accepted: 10/02/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Recent reports have highlighted the emergence of 'wasp dope' as an issue of concern, but epidemiological evidence is lacking. Wasp dope is a crystalline substance created by electrifying pyrethroid-containing insecticides (e.g. wasp sprays) that may give users a methamphetamine-like 'rush'. This paper describes wasp dope use and correlates of use in a sample of people who use drugs (PWUD) in Appalachian Kentucky, a region that has been an epicenter of opioid use and related harms in the United States. METHODS Respondent-driven sampling and targeted street outreach were used to recruit PWUD. Eligibility criteria included being aged at least 18 years, residing in one of five Appalachian Kentucky counties, and having either used opioids or injected any drug to get high in the prior 30 days. Interviewer-administered surveys queried participants' (n = 278) recent (past 6 months) wasp dope use, other substance use and demographic characteristics. Prevalence ratios (PR) were estimated using generalized estimating equations assuming a Poisson outcome distribution in a cross-sectional analysis. RESULTS Recent wasp dope use was reported by 16.1% of participants. Men and people who recently experienced homelessness and transportation difficulties were twice or more as likely to have used wasp dope compared with their counterparts [PR = 2.08, 95% confidence interval (CI) = 1.11, 3.87, PR = 2.78, 95% CI = 1.64, 4.72 and PR = 2.01, 95% CI = 1.06-3.81, respectively]. While wasp dope use was associated with injection drug use and using opioids and other substances to get high in unadjusted analyses, the factor most strongly associated with wasp dope use was methamphetamine use (PR = 17.23, 95% CI = 2.57, 115.61), specifically methamphetamine injection (PR = 4.47, 95% CI = 1.56, 12.78). CONCLUSIONS Among people who use drugs in rural Kentucky, USA, more than one in six people surveyed reported using wasp dope in the past 6 months, nearing the percentage using cocaine/crack (20%) and fentanyl/carfentanil (25%). Wasp dope use was higher among men and strongly associated with homelessness, transportation access, methamphetamine use and injection drug use.
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Affiliation(s)
- April M Young
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky,Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Melvin Livingston
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Rachel Vickers-Smith
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky,Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky,School of Nursing, University of Louisville, Louisville, Kentucky
| | - Hannah LF Cooper
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia
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Ibragimov U, Cooper KE, Batty E, Ballard AM, Fadanelli M, Gross SB, Klein EM, Lockard S, Young AM, Cooper HLF. Factors that influence enrollment in syringe services programs in rural areas: a qualitative study among program clients in Appalachian Kentucky. Harm Reduct J 2021; 18:68. [PMID: 34193165 PMCID: PMC8244225 DOI: 10.1186/s12954-021-00518-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/17/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Enrolling sufficient number of people who inject drugs (PWID) into syringe services programs (SSP) is important to curtail outbreaks of drug-related harms. Still, little is known about barriers and facilitators to SSP enrollment in rural areas with no history of such programs. This study's purpose was to develop a grounded theory of the role of the risk environment and individual characteristics of PWID in shaping SSP enrollment in rural Kentucky. METHODS We conducted one-on-one semi-structured interviews with 41 clients of 5 SSPs that were established in rural counties in Appalachian Kentucky in 2017-2018. Interviews covered PWID needs, the process of becoming aware of SSPs, and barriers and facilitators to SSP enrollment. Applying constructivist grounded theory methods and guided by the Intersectional Risk Environment Framework (IREF), we applied open, axial and selective coding to develop the grounded theory. RESULTS Stigma, a feature of IREF's meso-level social domain, is the main factor hampering SSP enrollment. PWID hesitated to visit SSPs because of internalized stigma and because of anticipated stigma from police, friends, family and healthcare providers. Fear of stigma was often mitigated or amplified by a constellation of meso-level environmental factors related to healthcare (e.g., SSPs) and social (PWID networks) domains and by PWID's individual characteristics. SSPs mitigated stigma as a barrier to enrollment by providing low threshold services in a friendly atmosphere, and by offering their clients program IDs to protect them from paraphernalia charges. SSP clients spread positive information about the program within PWID networks and helped their hesitant peers to enroll by accompanying them to SSPs. Individual characteristics, including child custody, employment or high social status, made certain PWID more susceptible to drug-related stigma and hence more likely to delay SSP enrollment. CONCLUSIONS Features of the social and healthcare environments operating at the meso-level, as well as PWID's individual characteristics, appear to enhance or mitigate the effect of stigma as a barrier to SSP enrollment. SSPs opening in locations with high stigma against PWID need to ensure low threshold and friendly services, protect their clients from police and mobilize PWID networks to promote enrollment.
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Affiliation(s)
| | | | - Evan Batty
- University of Kentucky College of Public Health, Lexington, KY, USA
| | - April M Ballard
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Monica Fadanelli
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Skylar B Gross
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Emma M Klein
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Scott Lockard
- Kentucky River District Health Department, Hazard, KY, USA
| | - April M Young
- University of Kentucky College of Public Health, Lexington, KY, USA
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Rudolph AE, Upton E, Young AM, Havens JR. Social network predictors of recent and sustained injection drug use cessation: findings from a longitudinal cohort study. Addiction 2021; 116:856-864. [PMID: 32812273 PMCID: PMC7889767 DOI: 10.1111/add.15218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/16/2020] [Accepted: 08/03/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS The US opioid crisis has led to increases in overdose fatalities and the incidence of HIV, hepatitis C and other infections. This analysis examines social network predictors of recent (self-report injection followed by non-injection) and sustained (self-report non-injection at two consecutive visits among those who previously injected) injection cessation in Appalachian Kentucky. DESIGN Data were collected through bi-annual longitudinal assessments for Social Networks among Appalachian People (SNAP; 2008-17). Using logistic regression with generalized estimating equations that clustered on individuals, we regressed non-injection status on the number of social network members who (a) did not inject and (b) recently stopped injecting and tested for interactions between each social network exposure and prior non-injection status. Social network exposures were self-reported. SETTING Rural eastern Kentucky, USA. PARTICIPANTS Participants entered the analysis only after reporting recent injection and had to have had at least two consecutive study visits (n = 326). MEASUREMENTS Interviewer-administered surveys collected individual-level socio-demographics, recent (past 6 months) drug use behaviors and the names of recent social support, sex and drug-use partners. FINDINGS After adjusting for confounders, the number of non-injecting social network members was positively associated with recent/sustained injection cessation (adjusted odds ratio = 1.27; 95% confidence interval = 1.13-1.42) and having more social network members was associated with reduced odds of recent/sustained injection cessation. The number of previously injecting social network members who had recently stopped injecting was not statistically significantly associated with injection cessation. Neither of the interactions we tested for was statistically significant, suggesting that the relationships may be similar for those who recently stopped injecting versus had not injected for at least 1 year. CONCLUSIONS For each additional network member who did not inject drugs, there was an increased odds of recent and sustained injection cessation among people with a history of injection drug use in Appalachian Kentucky.
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Affiliation(s)
- Abby E. Rudolph
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA
| | - Elizabeth Upton
- Department of Mathematics and Statistics, Williams College, Williamstown, MA, USA
| | - April M. Young
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky, College of Medicine, Lexington, KY, USA
- Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA
| | - Jennifer R. Havens
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky, College of Medicine, Lexington, KY, USA
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Stone J, Degenhardt L, Grebely J, Larney S, Altice FL, Smyrnov P, Rahimi-Movaghar A, Alavi M, Young AM, Havens JR, Miller WC, Hickman M, Vickerman P. Modelling the intervention effect of opioid agonist treatment on multiple mortality outcomes in people who inject drugs: a three-setting analysis. Lancet Psychiatry 2021; 8:301-309. [PMID: 33640039 PMCID: PMC8255389 DOI: 10.1016/s2215-0366(20)30538-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/25/2020] [Accepted: 12/02/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Opioid agonist treatment (OAT) reduces many of the harms associated with opioid dependence. We use mathematical modelling to comprehensively evaluate the overall health benefits of OAT in people who inject drugs in Perry County (KY, USA), Kyiv (Ukraine), and Tehran (Iran). METHODS We developed a dynamic model of HIV and hepatitis C virus (HCV) transmission, incarceration, and mortality through overdose, injury, suicide, disease-related and other causes. The model was calibrated to site-specific data using Bayesian methods. We evaluated preventable drug-related deaths (deaths due to HIV, HCV, overdose, suicide, or injury) averted over 2020-40 for four scenarios, added incrementally, compared with a scenario without OAT: existing OAT coverage (setting-dependent; community 4-11%; prison 0-40%); scaling up community OAT to 40% coverage; increasing average OAT duration from 4-14 months to 2 years; and scaling up prison-based OAT. OUTCOMES Drug-related harms contributed differentially to mortality across settings: overdose contributed 27-47% (range of median projections) of preventable drug-related deaths over 2020-40, suicide 6-17%, injury 3-17%, HIV 0-59%, and HCV 2-18%. Existing OAT coverage in Tehran (31%) could have a substantial effect, averting 13% of preventable drug-related deaths, but will have negligible effect (averting <2% of preventable drug-related deaths) in Kyiv and Perry County due to low OAT coverage (<4%). Scaling up community OAT to 40% could avert 12-24% of preventable drug-related deaths, including 13-22% of overdose deaths, with greater effect in settings with significant HIV mortality (Tehran and Kyiv). Improving OAT retention and providing prison-based OAT would have a significant additional effect, averting 27-51% of preventable drug-related deaths. INTERPRETATION OAT can substantially reduce drug-related harms, particularly in settings with HIV epidemics in people who inject drugs. Maximising these effects requires research and investment into achieving higher coverage and provision and longer retention of OAT in prisons and the community. FUNDING UK National Institute for Health Research, US National Institute on Drug Abuse.
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Affiliation(s)
- Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Jason Grebely
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; Département de Médecine Famille et de Médecine d'Urgence, Université de Montréal, Montréal, QC, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Frederick L Altice
- Section of Infectious Diseases, Department of Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | | | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Alavi
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - April M Young
- Center on Drug and Alcohol Research, Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA; Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Jennifer R Havens
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - William C Miller
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, USA
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Abstract
New HIV infections associated with injection drug use are of major concern in rural US communities. This study explores acceptability of, consent for, and uptake of free at-home HIV testing among people who use drugs (PWUD) in one of the nation’s epicenters for drug-related harms and HIV vulnerability: Rural Central Appalachia. Eligible participants were 18–35 years old, lived in Appalachian Kentucky, and reported using opioids to get high in the previous 30 days. A majority reported being likely (63.6%, 96/151) to take a free at-home HIV tests and 66.9% (101/151) consented to receive one. Among those who were randomly selected to receive a Home Access HIV-1 test kit (n = 37), 37.8% mailed in blood spots and 21.6% called to receive results. This study provides evidence that PWUD may be willing to take an at-home test, but other barriers may inhibit actual completion.
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Affiliation(s)
- April M Ballard
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA.
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30329, USA.
| | - Regine Haardöerfer
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Nadya Prood
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Chukwudi Mbagwu
- Department of Preventive Medicine and Environmental Health, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Hannah L F Cooper
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - April M Young
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
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Havens JR, Knudsen HK, Strickland JC, Young AM, Babalonis S, Lofwall MR, Walsh SL. Recent Increase in Methamphetamine Use in a Cohort of Rural People Who Use Drugs: Further Evidence for the Emergence of Twin Epidemics. Front Psychiatry 2021; 12:805002. [PMID: 35069295 PMCID: PMC8777215 DOI: 10.3389/fpsyt.2021.805002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/16/2021] [Indexed: 01/14/2023] Open
Abstract
Appalachian Kentucky was at the epicenter of the prescription opioid epidemic in the early 2000's. As we enter the third decade of the epidemic, patterns have begun to emerge as people who use drugs (PWUD) transition from use of opioids to other drugs. The purpose of this analysis was to examine longitudinal changes in methamphetamine use in an ongoing cohort of rural people who use drugs (PWUD) in Appalachian Kentucky. All but five of the cohort participants (N = 503) reported nonmedical prescription opioid use (NMPOU) at baseline and those 498 are included in this longitudinal analysis encompassing eight waves of data (2008-2020). Past 6-month use of methamphetamine was the dependent variable. Given the correlated nature of the data, mixed effects logistic regression was utilized to examine changes in methamphetamine use over time. Significant increases in methamphetamine use were observed over the past decade in this cohort of PWUD, especially in recent years (2017-2020). Prevalence of recent use at baseline and each of the follow-up visits was as follows: 9.4, 5.6, 5.0, 5.4, 8.1, 6.8, 6.9, and 33.1%, respectively (p < 0.001). On the contrary, significant reductions in NMPO and heroin use were observed in the same time period. The odds of methamphetamine use at the most recent visit were 25.8 times greater than at baseline (95% CI: 14.9, 44.6) and 52.6% of those reporting methamphetamine use reported injecting the drug. These results provide further evidence of "twin epidemics" of methamphetamine use among NMPOU. While problematic on several fronts, of particular concern is the lack of effective treatment options for methamphetamine use disorder. As policies around the opioid epidemic continue to evolve, particular attention should be paid to the surge in stimulant use in opioid-endemic areas.
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Affiliation(s)
- Jennifer R Havens
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Hannah K Knudsen
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - April M Young
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, United States.,Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, United States
| | - Shanna Babalonis
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Michelle R Lofwall
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Sharon L Walsh
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, United States
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Walsh SL, El-Bassel N, Jackson RD, Samet JH, Aggarwal M, Aldridge AP, Baker T, Barbosa C, Barocas JA, Battaglia TA, Beers D, Bernson D, Bowers-Sword R, Bridden C, Brown JL, Bush HM, Bush JL, Button A, Campbell AN, Cerda M, Cheng DM, Chhatwal J, Clarke T, Conway KP, Crable EL, Czajkowski A, David JL, Drainoni ML, Fanucchi LC, Feaster DJ, Fernandez S, Freedman D, Freisthler B, Gilbert L, Glasgow LM, Goddard-Eckrich D, Gutnick D, Harlow K, Helme DW, Huang T, Huerta TR, Hunt T, Hyder A, Kerner R, Keyes K, Knott CE, Knudsen HK, Konstan M, Larochelle MR, Craig Lefebvre R, Levin F, Lewis N, Linas BP, Lofwall MR, Lounsbury D, Lyons MS, Mann S, Marks KR, McAlearney A, McCollister KE, McCrimmon T, Miles J, Miller CC, Nash D, Nunes E, Oga EA, Oser CB, Plouck T, Rapkin B, Freeman PR, Rodriguez S, Root E, Rosen-Metsch L, Sabounchi N, Saitz R, Salsberry P, Savitsky C, Schackman BR, Seiber EE, Slater MD, Slavova S, Speer D, Martinez LS, Stambaugh LF, Staton M, Stein MD, Stevens-Watkins DJ, Surratt HL, Talbert JC, Thompson KL, Toussant K, Vandergrift NA, Villani J, Walker DM, Walley AY, Walters ST, Westgate PM, Winhusen T, Wu E, Young AM, Young G, Zarkin GA, Chandler RK. The HEALing (Helping to End Addiction Long-term SM) Communities Study: Protocol for a cluster randomized trial at the community level to reduce opioid overdose deaths through implementation of an integrated set of evidence-based practices. Drug Alcohol Depend 2020; 217:108335. [PMID: 33248391 PMCID: PMC7568493 DOI: 10.1016/j.drugalcdep.2020.108335] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Opioid overdose deaths remain high in the U.S. Despite having effective interventions to prevent overdose deaths, there are numerous barriers that impede their adoption. The primary aim of the HEALing Communities Study (HCS) is to determine the impact of an intervention consisting of community-engaged, data-driven selection, and implementation of an integrated set of evidence-based practices (EBPs) on reducing opioid overdose deaths. METHODS The HCS is a four year multi-site, parallel-group, cluster randomized wait-list controlled trial. Communities (n = 67) in Kentucky, Massachusetts, New York and Ohio are randomized to active intervention (Wave 1), which starts the intervention in Year 1 or the wait-list control (Wave 2), which starts the intervention in Year 3. The HCS will test a conceptually driven framework to assist communities in selecting and adopting EBPs with three components: 1) a community engagement strategy with local coalitions to guide and implement the intervention; 2) a compendium of EBPs coupled with technical assistance; and 3) a series of communication campaigns to increase awareness and demand for EBPs and reduce stigma. An implementation science framework guides the intervention and allows for examination of the multilevel contexts that promote or impede adoption and expansion of EBPs. The primary outcome, number of opioid overdose deaths, will be compared between Wave 1 and Wave 2 communities during Year 2 of the intervention for Wave 1. Numerous secondary outcomes will be examined. DISCUSSION The HCS is the largest community-based implementation study in the field of addiction with an ambitious goal of significantly reducing fatal opioid overdoses.
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Cooper HL, Cloud DH, Freeman PR, Fadanelli M, Green T, Van Meter C, Beane S, Ibragimov U, Young AM. Buprenorphine dispensing in an epicenter of the U.S. opioid epidemic: A case study of the rural risk environment in Appalachian Kentucky. Int J Drug Policy 2020; 85:102701. [PMID: 32223985 PMCID: PMC7529684 DOI: 10.1016/j.drugpo.2020.102701] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 01/24/2020] [Accepted: 02/16/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Buprenorphine is a cornerstone to curbing opioid epidemics, but emerging data suggest that rural pharmacists in the US sometimes refuse to dispense this medication. We conducted a case study to explore buprenorphine dispensing practices in 12 rural Appalachian Kentucky counties, and analyze whether and how they were shaped by features of the rural risk environment. METHODS In this case study, we conducted one-on-one semi-structured interviews with 14 pharmacists operating 15 pharmacies in these counties to explore buprenorphine dispensing practices and perceived influences on these practices. Thematic analyses of the resulting transcripts revealed three features of the rural risk environment that shaped dispensing. To explore these three risk environment features, we analyzed policy documents (e.g., Attorney General lawsuits) and administrative databases (e.g., incarceration data). Textual documents were analyzed using thematic analyses and administrative data were analyzed using descriptive statistics; memoes explored relationships among risk environment features and dispensing practices. RESULTS Twelve of the 15 pharmacies limited dispensing, by refusing to serve new patients; limiting dispensing to known patients or prescribers; or refusing to dispense buprenorphine altogether. Concerns about exceeding a "Drug Enforcement Administration (DEA) cap" on opioid dispensing stifled dispensing. A legacy of aggressive and fraudulent marketing of opioid analgesics (OAs) by pharmaceutical companies and physician OA overprescribing undermined pharmacist trust in buprenorphine and in its prescribers. The escalating local war on drugs may have undermined dispensing by reinforcing stigma against people who use drugs. CONCLUSIONS Initiatives to increase buprenorphine prescribing must be accompanied by policy changes to increase dispensing. Specifically, buprenorphine should be removed from opioid monitoring systems; efforts to de-escalate the war on drugs should be extended to encompass rural areas; initiatives to dismantle aggressive OA marketing should be strengthened; and efforts to re-build pharmacist trust in physicians are needed.
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Affiliation(s)
| | - David H Cloud
- Emory University Rollins School of Public Health, Atlanta GA
| | | | | | - Travis Green
- University of Kentucky College of Public Health, Lexington KY
| | | | - Stephanie Beane
- Emory University Rollins School of Public Health, Atlanta GA
| | | | - April M Young
- University of Kentucky College of Public Health, Lexington KY
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40
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Havens JR, Knudsen HK, Young AM, Lofwall MR, Walsh SL. Longitudinal trends in nonmedical prescription opioid use in a cohort of rural Appalachian people who use drugs. Prev Med 2020; 140:106194. [PMID: 32652132 PMCID: PMC7680378 DOI: 10.1016/j.ypmed.2020.106194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/13/2020] [Accepted: 07/05/2020] [Indexed: 01/22/2023]
Abstract
Rural Appalachia remains an epicenter of the prescription opioid epidemic. In 2008, a cohort study was undertaken to examine longitudinal trends in nonmedical prescription opioid use (NMPOU). Eight waves of data (2008-2020) from the Social Networks among Appalachian People (SNAP) cohort were utilized for the current analysis. Only those who reported recent (past 6-month) NMPOU at baseline are included (n = 498, 99%). Mixed-effects logistic regression was used to model factors associated with NMPOU over time. Recent NMPOU declined significantly over the past decade (p < .001). However, 54.1% of participants still engaged in NMPOU at their most recent follow-up. Receipt of benefits for a physical or mental disability (adjusted odds ratio [aOR]: 3.11, 95% Confidence Interval [CI]: 1.98, 4.90) and self-described poor health status (aOR: 3.67, 95% CI: 1.61, 8.37) were both associated with NMPOU. All treatment modalities (methadone maintenance, residential, outpatient counseling) tested in the model, with the notable exception of detoxification, were associated with significantly lower odds of NMPOU. Although significant declines in prescription opioid misuse were observed in the cohort, more than half of all participants were engaged in NMPOU more than a decade after entering the study. Substance use disorder (SUD) treatment (excluding detoxification) was shown associated with reduced odds of continued NMPOU; therefore, increasing access to evidence-based treatments should be a priority in rural areas affected by the ongoing opioid epidemic.
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Affiliation(s)
- Jennifer R Havens
- Center on Drug and Alcohol Use, University of Kentucky College of Medicine, United States of America; Department of Behavioral Science, University of Kentucky College of Medicine, United States of America.
| | - Hannah K Knudsen
- Center on Drug and Alcohol Use, University of Kentucky College of Medicine, United States of America; Department of Behavioral Science, University of Kentucky College of Medicine, United States of America
| | - April M Young
- Center on Drug and Alcohol Use, University of Kentucky College of Medicine, United States of America; Department of Epidemiology, University of Kentucky College of Public Health, United States of America
| | - Michelle R Lofwall
- Center on Drug and Alcohol Use, University of Kentucky College of Medicine, United States of America; Department of Behavioral Science, University of Kentucky College of Medicine, United States of America
| | - Sharon L Walsh
- Center on Drug and Alcohol Use, University of Kentucky College of Medicine, United States of America; Department of Behavioral Science, University of Kentucky College of Medicine, United States of America
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Ibragimov U, Young AM, Cooper HLF. Understanding rural risk environments for drug-related harms: Progress, challenges, and steps forward. Int J Drug Policy 2020; 85:102926. [PMID: 32912825 PMCID: PMC8215764 DOI: 10.1016/j.drugpo.2020.102926] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/09/2020] [Accepted: 08/13/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Umedjon Ibragimov
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
| | - April M Young
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Hannah L F Cooper
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Young AM, Ballard AM, Cooper HLF. Novel Recruitment Methods for Research Among Young Adults in Rural Areas Who Use Opioids: Cookouts, Coupons, and Community-Based Staff. Public Health Rep 2020; 135:746-755. [PMID: 32933438 DOI: 10.1177/0033354920954796] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Rural communities in the United States are increasingly becoming epicenters of substance use and related harms. However, best practices for recruiting rural people who use drugs (PWUD) for epidemiologic research are unknown, because such strategies were developed in cities. This study explores the feasibility of web- and community-based strategies to recruit rural, young adult PWUD into epidemiologic research. MATERIALS AND METHODS We recruited PWUD from rural Kentucky to participate in a web-based survey about opioid use using web-based peer referral and community-based strategies, including cookouts, flyers, street outreach, and invitations to PWUD enrolled in a concurrent substance use study. Staff members labeled recruitment materials with unique codes to enable tracking. We assessed eligibility and fraud through online eligibility screening and a fraud detection algorithm, respectively. Eligibility criteria included being aged 18-35, recently using opioids to get high, and residing in the study area. RESULTS Recruitment yielded 410 complete screening entries, of which 234 were eligible and 151 provided complete, nonfraudulent surveys (ie, surveys that passed a fraud-detection algorithm designed to identify duplicate, nonlocal, and/or bot-generated entries). Cookouts and subsequent web-based peer referrals accounted for the highest proportion of screening entries (37.1%, n = 152), but only 29.6% (n = 45) of entries from cookouts and subsequent web-based peer referrals resulted in eligible, nonfraudulent surveys. Recruitment and subsequent web-based peer referral from the concurrent study yielded the second most screening entries (27.8%, n = 114), 77.2% (n = 88) of which resulted in valid surveys. Other recruitment strategies combined to yield 35.1% (n = 144) of screening entries and 11.9% (n = 18) of valid surveys. CONCLUSIONS Web-based methods need to be complemented by context-tailored, street-outreach activities to recruit rural PWUD.
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Affiliation(s)
- April M Young
- 4530 Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA.,Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - April M Ballard
- 4530 Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA.,1371 Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Hannah L F Cooper
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
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Affiliation(s)
- Hannah L F Cooper
- From the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health at Emory University, Atlanta (H.L.F.C., D.H.C.); and the Department of Epidemiology, University of Kentucky College of Public Health (A.M.Y.) and the Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy (P.R.F.) - both in Lexington
| | - David H Cloud
- From the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health at Emory University, Atlanta (H.L.F.C., D.H.C.); and the Department of Epidemiology, University of Kentucky College of Public Health (A.M.Y.) and the Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy (P.R.F.) - both in Lexington
| | - April M Young
- From the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health at Emory University, Atlanta (H.L.F.C., D.H.C.); and the Department of Epidemiology, University of Kentucky College of Public Health (A.M.Y.) and the Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy (P.R.F.) - both in Lexington
| | - Patricia R Freeman
- From the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health at Emory University, Atlanta (H.L.F.C., D.H.C.); and the Department of Epidemiology, University of Kentucky College of Public Health (A.M.Y.) and the Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy (P.R.F.) - both in Lexington
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Stone J, Fraser H, Young AM, Havens JR, Vickerman P. Modeling the role of incarceration in HCV transmission and prevention amongst people who inject drugs in rural Kentucky. Int J Drug Policy 2020; 88:102707. [PMID: 32151496 PMCID: PMC7483428 DOI: 10.1016/j.drugpo.2020.102707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/23/2020] [Accepted: 02/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND People who inject drugs (PWID) experience high incarceration rates, with current/recent incarceration being associated with increased hepatitis C virus (HCV) transmission. We assess the contribution of incarceration to HCV transmission amongst PWID in Perry County (PC), Kentucky, USA, and the impact of scaling-up community and in-prison opioid substitution therapy (OST), including the potential for reducing incarceration. METHODS A dynamic model of incarceration and HCV transmission amongst PWID was calibrated in a Bayesian framework to epidemiological and incarceration data from PC, incorporating an empirically estimated 2.8-fold (95%CI: 1.36-5.77) elevated HCV acquisition risk amongst currently incarcerated or recently released (<6 months) PWID compared to other PWID. We projected the percentage of new HCV infections that would be prevented among PWID over 2020-2030 if incarceration no longer elevated HCV transmission risk, if needle and syringe programmes (NSP) and OST are scaled-up, and/or if drug use was decriminalized (incarceration/reincarceration rates are halved) with 50% of PWID that would have been imprisoned being diverted onto OST. We assume OST reduces reincarceration by 10-42%. RESULTS Over 2020-2030, removing the effect of incarceration on HCV transmission could prevent 42.7% (95% credibility interval: 15.0-67.4%) of new HCV infections amongst PWID. Conversely, scaling-up community OST and NSP to 50% coverage could prevent 28.5% (20.0-37.4%) of new infections, with this increasing to 32.7% (24.5-41.2%) if PWID are retained on OST upon incarceration, 36.4% (27.7-44.9%) if PWID initiate OST in prison, and 45.3% (35.9-54.1%) if PWID are retained on OST upon release. decriminalization (with diversion to OST) could further increase this impact, preventing 56.8% (45.3-64.5%) of new infections. The impact of these OST interventions decreases by 2.1-28.6% if OST does not reduce incarceration. CONCLUSION Incarceration is likely to be an important contributor to HCV transmission amongst PWID in PC. Prison-based OST could be an important intervention for reducing this risk.
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Affiliation(s)
- Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK.
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
| | - April M Young
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky, USA; Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Jennifer R Havens
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
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Lancaster KE, Cooper HLF, Browning CR, Malvestutto CD, Bridges JFP, Young AM. Syringe Service Program Utilization, Barriers, and Preferences for Design in Rural Appalachia: Differences between Men and Women Who Inject Drugs. Subst Use Misuse 2020; 55:2268-2277. [PMID: 32748730 PMCID: PMC7584727 DOI: 10.1080/10826084.2020.1800741] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background People who inject drugs (PWID) in rural areas of the United States have had limited access to syringe service programs (SSP). Rural SSP have recently surged, but accompanying research is lacking about PWID utilization, barriers, and preferences for SSP design and how those preferences vary by gender. Methods: Interviewer-administered surveys elicited information about utilization, barriers, and preferences for SSP design from 234 PWID recruited using respondent-driven sampling in Appalachian, Kentucky. Gender differences among reported barriers to utilizing SSP and preferences for program design were explored using Mantel-Haenszel chi-square tests. Results: Overall, 49% of PWID had ever utilized an SSP. The most common reasons for not utilizing an SSP were lack of awareness (23%), fear of being seen or disclosing drug use (19%), and lack of need (19%). The most preferred SSP design was located within a health department (74%) and operating during afternoon hours (66%). Men were more likely than women to prefer SSP in health departments (80% vs. 65%, p = 0.01), while more women than men preferred staffing by health department personnel (62% vs. 46%, p = 0.02). Women were less likely to favor evening hours (55% vs. 70%, p = 0.02). Fewer women wanted SSP nurses (78% vs. 90%, p = 0.01), social workers (11% vs. 24%, p = 0.01), or people who use drugs (20% vs 34%, p = 0.02) to staff SSP. Conclusions: Despite recent scale-up, SSP in Appalachia remain under-utilized. PWID were open to a range of options for SSP design and staffing, though there were variations by gender. Implementation research that identifies best strategies for tailored SSP scale-up in rural settings should be considered.
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Affiliation(s)
- Kathryn E Lancaster
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Hannah L F Cooper
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | | | - Carlos D Malvestutto
- Division of Infectious Diseases, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - John F P Bridges
- Departments of Biomedical Informatics and Surgery, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - April M Young
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA.,Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
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Fadanelli M, Cloud DH, Ibragimov U, Ballard AM, Prood N, Young AM, Cooper HLF. People, places, and stigma: A qualitative study exploring the overdose risk environment in rural Kentucky. Int J Drug Policy 2019; 85:102588. [PMID: 31753603 DOI: 10.1016/j.drugpo.2019.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/20/2019] [Accepted: 11/02/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Though overdose rates have been increasing in US rural areas for two decades, little is known about the rural risk environment for overdoses. This qualitative study explored the risk environment for overdoses among young adults in Eastern Kentucky, a rural epicenter of the US opioid epidemic. METHODS Participants were recruited via community-based outreach. Eligibility criteria included living in one of five rural Eastern Kentucky counties; being aged 18-35; and using opioids to get high in the past 30 days. Semi-structured interviews explored the rural risk environment, and strategies to prevent overdose and dying from an overdose. Interviews were transcribed verbatim and analyzed using constructivist grounded-theory methods. RESULTS In this sample (N = 19), participants reported using in a range of locations, including homes and outdoor settings; concerns about community stigma and law enforcement shaped the settings where participants used opioids and the strategies they deployed in these settings to prevent an overdose, and to survive an overdose. Almost half of participants reported using opioids in a "trap house" or other dealing locations, often to evade police after buying drugs, and reported that others present pressed them to use more than usual. If an overdose occurred in this setting, however, these same people might refuse to call EMS to protect themselves from arrest. Outdoor settings presented particular vulnerabilities to overdose and dying from an overdose. Most participants reported using opioids outdoors, where they skipped overdose prevention steps to reduce their risk of arrest; they worried that no one would find them if they overdosed, and that cell phone coverage would be too weak to summon EMS. CONCLUSION Findings suggest that initiatives to reduce overdoses in Eastern Kentucky would be strengthened by de-escalating the War on Drugs and engaging law enforcement in initiatives to protect the health of people who use opioids.
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Affiliation(s)
- Monica Fadanelli
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA.
| | - David H Cloud
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA
| | - Umedjon Ibragimov
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA
| | - April M Ballard
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA
| | - Nadya Prood
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA
| | - April M Young
- College of Public Health, University of Kentucky, 111 Washington Ave, Lexington, KY 40536, USA; Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Lexington, KY 40508, USA
| | - Hannah L F Cooper
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA
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Rudolph AE, Upton E, McDonald MJ, Young AM, Havens JR. Peer influence of injection drug use cessation among dyads in rural eastern Kentucky. Int J Drug Policy 2019; 85:102604. [PMID: 31740176 DOI: 10.1016/j.drugpo.2019.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/30/2019] [Accepted: 11/10/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND This analysis aims to assess whether injection drug use cessation among peers predicts injection drug use cessation among individuals and explores whether this association varies by relationship type and strength. METHODS Data were collected through baseline and 6-month assessments for the Social Networks among Appalachian People study (2008-2011). Interviewer-administered surveys collected sociodemographic and drug use behaviors (past 6 months and lifetime). Participants also listed sex, drug use, and social support partners (past 6 months). Listed names were cross-referenced with survey participants to identify relationships between study participants. The analytic sample was further restricted to include only those relationship pairs where both individuals reported a history of injection drug use at baseline (n = 244 unique individuals and 746 dyads). We fit a generalized estimating equations logistic regression model to (1) assess the relationship between peer injection cessation and individual injection cessation and (2) determine whether the strength of this association differs by relationship-level variables (i.e., relationship role, relationship type, relationship duration, frequency of interaction, residential proximity). RESULTS Overall, those with a network member who ceased injection drug use were more likely to stop injecting over the following 6-month period (AOR=1.65). The magnitude of this association was greater for social support partners (AOR=2.95), family members (AOR=3.56), those with whom the participant interacted at least daily (AOR=2.17), and those who the participant knew longer (AOR=2.09). Further, among family members, the effect size was greater when relationships were further restricted to immediate family members (AOR=5.35). CONCLUSION Our findings suggest that in this rural community, closer, more supportive relationships, may be more influential for modeling injection cessation; however, relationship-types were not mutually exclusive so differences in effect size across strata may not be statistically significant. In this setting, social support through the recovery process (including cessation attempts with peers) may increase likelihood of injection cessation.
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Affiliation(s)
- Abby E Rudolph
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, United States.
| | - Elizabeth Upton
- Department of Mathematics and Statistics, Boston University, Boston, MA, United States; Department of Mathematics and Statistics, Williams College, Williamstown, MA, United States
| | - Madelyn J McDonald
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, United States
| | - April M Young
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, United States; Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, United States; Center for Health Equity Transformation, University of Kentucky, Lexington, KY, United States
| | - Jennifer R Havens
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, United States
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Cooper HLF, Crawford ND, Haardörfer R, Prood N, Jones-Harrell C, Ibragimov U, Ballard AM, Young AM. Using Web-Based Pin-Drop Maps to Capture Activity Spaces Among Young Adults Who Use Drugs in Rural Areas: Cross-Sectional Survey. JMIR Public Health Surveill 2019; 5:e13593. [PMID: 31628787 PMCID: PMC6913769 DOI: 10.2196/13593] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/08/2019] [Accepted: 03/11/2019] [Indexed: 11/13/2022] Open
Abstract
Background Epicenters of harmful drug use are expanding to US rural areas, with rural young adults bearing a disproportionate burden. A large body of work suggests that place characteristics (eg, spatial access to health services) shape vulnerability to drug-related harms among urban residents. Research on the role of place characteristics in shaping these harms among rural residents is nascent, as are methods of gathering place-based data. Objective We (1) analyzed whether young rural adults who used drugs answered self-administered Web-based mapping items about locations where they engaged in risk behaviors and (2) determined the precision of mapped locations. Methods Eligible individuals had to report recently using opioids to get high; be aged between 18 and 35 years; and live in the 5-county rural Appalachian Kentucky study area. We used targeted outreach and peer-referral methods to recruit participants. The survey asked participants to drop a pin in interactive maps to mark where they completed the survey, and where they had slept most; used drugs most; and had sex most in the past 6 months. Precision was assessed by (1) determining whether mapped locations were within 100 m of a structure and (2) calculating the Euclidean distance between the pin-drop home location and the street address where participants reported sleeping most often. Measures of central tendency and dispersion were calculated for all variables; distributions of missingness for mapping items and for the Euclidean distance variable were explored across participant characteristics. Results Of the 151 participants, 88.7% (134/151) completed all mapping items, and ≥92.1% (>139/151) dropped a pin at each of the 4 locations queried. Missingness did not vary across most participant characteristics, except that lower percentages of full-time workers and peer-recruited participants mapped some locations. Two-thirds of the pin-drop sex and drug use locations were less than 100 m from a structure, as were 92.1% (139/151) of pin-drop home locations. The median distance between the pin-drop and street-address home locations was 2.0 miles (25th percentile=0.8 miles; 75th percentile=5.5 miles); distances were shorter for high-school graduates, staff-recruited participants, and participants reporting no technical difficulties completing the survey. Conclusions Missingness for mapping items was low and unlikely to introduce bias, given that it varied across few participant characteristics. Precision results were mixed. In a rural study area of 1378 square miles, most pin-drop home addresses were near a structure; it is unsurprising that fewer drug and sex locations were near structures because most participants reported engaging in these activities outside at times. The error in pin-drop home locations, however, might be too large for some purposes. We offer several recommendations to strengthen future research, including gathering metadata on the extent to which participants zoom in on each map and recruiting participants via trusted staff.
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Affiliation(s)
| | - Natalie D Crawford
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Regine Haardörfer
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Nadya Prood
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Carla Jones-Harrell
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Umedjon Ibragimov
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - April M Ballard
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - April M Young
- College of Public Health, University of Kentucky, Lexington, KY, United States
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Ward PJ, Rock PJ, Slavova S, Young AM, Bunn TL, Kavuluru R. Enhancing timeliness of drug overdose mortality surveillance: A machine learning approach. PLoS One 2019; 14:e0223318. [PMID: 31618226 PMCID: PMC6795484 DOI: 10.1371/journal.pone.0223318] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 09/18/2019] [Indexed: 11/26/2022] Open
Abstract
Background Timely data is key to effective public health responses to epidemics. Drug overdose deaths are identified in surveillance systems through ICD-10 codes present on death certificates. ICD-10 coding takes time, but free-text information is available on death certificates prior to ICD-10 coding. The objective of this study was to develop a machine learning method to classify free-text death certificates as drug overdoses to provide faster drug overdose mortality surveillance. Methods Using 2017–2018 Kentucky death certificate data, free-text fields were tokenized and features were created from these tokens using natural language processing (NLP). Word, bigram, and trigram features were created as well as features indicating the part-of-speech of each word. These features were then used to train machine learning classifiers on 2017 data. The resulting models were tested on 2018 Kentucky data and compared to a simple rule-based classification approach. Documented code for this method is available for reuse and extensions: https://github.com/pjward5656/dcnlp. Results The top scoring machine learning model achieved 0.96 positive predictive value (PPV) and 0.98 sensitivity for an F-score of 0.97 in identification of fatal drug overdoses on test data. This machine learning model achieved significantly higher performance for sensitivity (p<0.001) than the rule-based approach. Additional feature engineering may improve the model’s prediction. This model can be deployed on death certificates as soon as the free-text is available, eliminating the time needed to code the death certificates. Conclusion Machine learning using natural language processing is a relatively new approach in the context of surveillance of health conditions. This method presents an accessible application of machine learning that improves the timeliness of drug overdose mortality surveillance. As such, it can be employed to inform public health responses to the drug overdose epidemic in near-real time as opposed to several weeks following events.
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Affiliation(s)
- Patrick J. Ward
- Kentucky Injury Prevention and Research Center, College of Public Health, University of Kentucky, Lexington, Kentucky, United States of America
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, Kentucky, United States of America
- * E-mail:
| | - Peter J. Rock
- Kentucky Injury Prevention and Research Center, College of Public Health, University of Kentucky, Lexington, Kentucky, United States of America
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, Kentucky, United States of America
| | - Svetla Slavova
- Kentucky Injury Prevention and Research Center, College of Public Health, University of Kentucky, Lexington, Kentucky, United States of America
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, United States of America
| | - April M. Young
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, Kentucky, United States of America
- Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, Lexington, Kentucky, United States of America
| | - Terry L. Bunn
- Kentucky Injury Prevention and Research Center, College of Public Health, University of Kentucky, Lexington, Kentucky, United States of America
- Department of Preventive Medicine and Environmental Health, College of Public Health, University of Kentucky, Lexington, Kentucky, United States of America
| | - Ramakanth Kavuluru
- Department of Computer Science, College of Engineering, University of Kentucky, Lexington, Kentucky, United States of America
- Division of Biomedical Informatics, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky, United States of America
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Fraser H, Vellozzi C, Hoerger TJ, Evans JL, Kral AH, Havens J, Young AM, Stone J, Handanagic S, Hariri S, Barbosa C, Hickman M, Leib A, Martin NK, Nerlander L, Raymond HF, Page K, Zibbell J, Ward JW, Vickerman P. Scaling Up Hepatitis C Prevention and Treatment Interventions for Achieving Elimination in the United States: A Rural and Urban Comparison. Am J Epidemiol 2019; 188:1539-1551. [PMID: 31150044 PMCID: PMC7415256 DOI: 10.1093/aje/kwz097] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 12/14/2022] Open
Abstract
In the United States, hepatitis C virus (HCV) transmission is rising among people who inject drugs (PWID). Many regions have insufficient prevention intervention coverage. Using modeling, we investigated the impact of scaling up prevention and treatment interventions on HCV transmission among PWID in Perry County, Kentucky, and San Francisco, California, where HCV seroprevalence among PWID is >50%. A greater proportion of PWID access medication-assisted treatment (MAT) or syringe service programs (SSP) in urban San Francisco (established community) than in rural Perry County (young, expanding community). We modeled the proportion of HCV-infected PWID needing HCV treatment annually to reduce HCV incidence by 90% by 2030, with and without MAT scale-up (50% coverage, both settings) and SSP scale-up (Perry County only) from 2017. With current MAT and SSP coverage during 2017-2030, HCV incidence would increase in Perry County (from 21.3 to 22.6 per 100 person-years) and decrease in San Francisco (from 12.9 to 11.9 per 100 person-years). With concurrent MAT and SSP scale-up, 5% per year of HCV-infected PWID would need HCV treatment in Perry County to achieve incidence targets-13% per year without MAT and SSP scale-up. In San Francisco, a similar proportion would need HCV treatment (10% per year) irrespective of MAT scale-up. Reaching the same impact by 2025 would require increases in treatment rates of 45%-82%. Achievable provision of HCV treatment, alongside MAT and SSP scale-up (Perry County) and MAT scale-up (San Francisco), could reduce HCV incidence.
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Affiliation(s)
- Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Claudia Vellozzi
- Division of Medical Affairs, Grady Health System, Atlanta, Georgia
| | - Thomas J Hoerger
- RTI International, Research Triangle Park, Raleigh, North Carolina
| | - Jennifer L Evans
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California
| | - Alex H Kral
- RTI International, Research Triangle Park, Raleigh, North Carolina
| | - Jennifer Havens
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky
| | - April M Young
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky
| | - Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Senad Handanagic
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan Hariri
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carolina Barbosa
- RTI International, Research Triangle Park, Raleigh, North Carolina
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Alyssa Leib
- Department of Chemistry, University of Colorado, Denver, Colorado
| | - Natasha K Martin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, California
| | - Lina Nerlander
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Henry F Raymond
- Center for Public Health Research, Population Health Division, San Francisco Department of Public Health, San Francisco, California
| | - Kimberly Page
- Department of Internal Medicine, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Jon Zibbell
- RTI International, Research Triangle Park, Raleigh, North Carolina
| | - John W Ward
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
- Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, Georgia
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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