In response to NOT-DA-20-047, Notice of Special Interest (NOSI) regarding the Availability of Administrative Supplements and Urgent Competitive Revisions for Research on the 2019 Novel Coronavirus, our research team proposes increase our understanding of drug use and syringe sharing behaviors, overdose, impacts of homelessness, and other potential barriers PWID face during COVID-19 by developing a phone based survey among PWID who participated in the first phase of the Wisconsin Rural Opioid Initiative. The survey will be embedded in our proposed virtual intervention adapted from our original proposal. Last, we will evaluate how restricted operations at the SSP changed utilization of syringe services and assess the feasibility of the use of at-home HIV and viral hepatitis testing and counseling by phone Using the organizational infrastructure of our local SSP, Vivent Health, a geographically disperse population of people who inject drugs in rural communities across Northern Wisconsin, we are building locally responsive systems to facilitate uptake of evidence-based prevention services for high-risk clients. Understanding information on how COVID-19 may change risk is needed to provide effective prevention and treatment to PWID. The growing problem of opioid injection in rural Wisconsin is highly significant because it exemplifies trends observed nationally indicating severe vulnerability to worsening epidemics of HIV, HCV, and opioid overdose deaths in rural communities that are substantially underserved by evidence-based prevention interventions. This proposal is highly innovative because it will enable us to use an evidence-based intervention in a unique way to reach clients during a global pandemic. Additionally, we have the ability to assess how the pandemic will have long-term effects on people who inject drugs that will inform future interventions. It has potential for high impact because of our team's state-wide reach, broad access to at-risk individuals, and robust infrastructure for conducting a rigorous, multi-site evaluation of our proposed model.
/ PUBLIC HEALTH RELEVANCE Rural-dwelling people who inject heroin and other opioids are a highly marginalized population. Poor access to medical and prevention services leaves residents of many rural U.S. communities vulnerable to preventable harms of injection drug use. Stay at home orders due to COVID-19, have increased the risk of these preventable harms across rural communities. The overall objective of this project is to implement a virtual service delivery model which has been replicated from our parent grant, Community-Based, Client-Centered Prevention Home. We will develop and evaluate a service coordination model within an existing network of rural syringe service programs and assess the impact of COVID-19 on people who inject drugs. We will also evaluate the organizational-level impact on mitigating the infectious disease consequences of injection drug use and overdose during operational changes during COVID-19 by evaluating at-home HIV and viral hepatitis C testing kits, and understanding geographical reach of syringe exchange.
