The overarching goal of this renewal application (R01DA033862) is to determine the influence of structural interventions on engagement in risk reduction and health promotion activities among rural Appalachian drug users. Results from the three-year R01 that the investigators seek to continue reveal an ever-changing landscape of prescription drug abuse; an epidemic that is still in its infancy. Unlike many rural and suburban areas, there is little evidence for the transition to heroin abuse. In this cohort, there has been marked shift from abuse of OxyContin(r) (extended-release oxycodone) to immediate release oxycodone to more recently, buprenorphine and gabapentin-containing products. In addition, rates of HCV prevalence and incidence are high, especially given the population density of rural Appalachia. Given the syndemic of opioid abuse and infectious disease transmission, two structural interventions are particularly relevant to this population of rural people who use drugs (PWUD). Medicaid (MC) expansion (under the Affordable Care Act [ACA]) and syringe access programs (SAP) are two structural interventions that may allow for increased engagement in health promotion among PWUD, but are likely heavily influenced by individual, network, and community-level factors. Utilizing Latkin's Dynamic Social Systems model and leveraging the extant, highly successful cohort of rural PWUD, the aims include: 1) examining how dynamic factors of these structural interventions influence longitudinal trends in illicit and prescription drug abuse; 2) determining the influence of these structural interventions on HIV/HCV incidence and engagement in risk reduction; and 3) assessing the influence of these structural interventions on uptake of substance abuse treatment. This study is highly significant given that understanding the mechanisms by which these specific structural interventions influence health promotion is key to improving public health in rural Appalachia. Substance abuse and HCV are two of the most important, if not the most important health issues facing this region already plagued with marked health disparities. Using innovative measures of network and geospatial risk, as well as conjoint analysis and multilevel longitudinal statistical models, results will not only inform development of interventions that optimize uptake and utilization of risk reduction services such as SAP and substance abuse treatment, but may inform policies surrounding further implementation of health promotion programs in the rural U.S.
Both MC expansion and SAPs have great potential to improve substance abuse and infectious disease outcomes among rural PWUD/PWID; however, first we must understand the mechanisms by which these SIs are influencing outcomes. Therefore, results may inform ways in which to optimize uptake and utilization of structural interventions, as well as to inform policies surrounding further implementation of SIs that will improve public health outcomes in rural Appalachia.
|Stone, Jack; Fraser, Hannah; Lim, Aaron G et al. (2018) Incarceration history and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis. Lancet Infect Dis 18:1397-1409|
|Young, April M; Rudolph, Abby E; Havens, Jennifer R (2018) Network-Based Research on Rural Opioid Use: an Overview of Methods and Lessons Learned. Curr HIV/AIDS Rep 15:113-119|
|Havens, Jennifer R; Walsh, Sharon L; Korthuis, P Todd et al. (2018) Implementing Treatment of Opioid-Use Disorder in Rural Settings: a Focus on HIV and Hepatitis C Prevention and Treatment. Curr HIV/AIDS Rep 15:315-323|
|Friedman, Samuel R; Williams, Leslie; Young, April M et al. (2018) Network Research Experiences in New York and Eastern Europe: Lessons for the Southern US in Understanding HIV Transmission Dynamics. Curr HIV/AIDS Rep 15:283-292|
|Vickers Smith, Rachel; Boland, Elaine M; Young, April M et al. (2018) A qualitative analysis of gabapentin misuse and diversion among people who use drugs in Appalachian Kentucky. Psychol Addict Behav 32:115-121|
|Stephens, Dustin B; Young, April M; Havens, Jennifer R (2017) Healthcare contact and treatment uptake following hepatitis C virus screening and counseling among rural Appalachian people who use drugs. Int J Drug Policy 47:86-94|
|Rudolph, Abby E; Young, April M; Havens, Jennifer R (2017) Examining the Social Context of Injection Drug Use: Social Proximity to Persons Who Inject Drugs Versus Geographic Proximity to Persons Who Inject Drugs. Am J Epidemiol 186:970-978|
|Rudolph, Abby E; Young, April M; Havens, Jennifer R (2017) A rural/urban comparison of privacy and confidentiality concerns associated with providing sensitive location information in epidemiologic research involving persons who use drugs. Addict Behav 74:106-111|
|Hofmeister, Megan G; Havens, Jennifer R; Young, April M (2017) Silence Surrounding Hepatitis C Status in Risk Relationships Among Rural People Who Use Drugs. J Prim Prev 38:481-494|
|Smith, Rachel V; Havens, Jennifer R; Walsh, Sharon L (2016) Gabapentin misuse, abuse and diversion: a systematic review. Addiction 111:1160-74|
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