Kentucky Communities and Researchers Engaging to Halt the Opioid Epidemic (CARE2HOPE)

Grants and Contracts Details

Description

The proposed project will build evidence-based, community-rooted public health responses to the epidemics of non-medical prescription opioid (NMPO) and heroin misuse, overdoses (ODs), and HCV, and to imminent HIV outbreaks, in 12 rural Appalachian Kentucky counties at epicenter of these intertwined national crises. Ten of these counties ranked in the top 5% for HIV/HCV vulnerability. Our studies have found high rates of HCV, injection drug use (IDU), rapid transitions to IDU, NMPO ODs, and condomless sex. Densely linked networks can kindle HIV outbreaks if seeding occurs. Most counties are in coal country, an RFA priority. Unfortunately, these counties exemplify an extreme version of the “implementation chasm,” a chasm dividing scientific knowledge from action. Evidence-based public health responses to these epidemics exist (e.g., syringe service programs [SSPs]) and are often deployed in cities. In these 12 rural counties, though, scarcities of resources and of providers conspire with drug-related stigma to constrain public health responses. The counties’ public health infrastructures are weak, their harm reduction infrastructures virtually non-existent. This project will bridge the implementation chasm in these 12 counties, and recognizes that bridging this chasm requires more than simply importing SSPs and other evidence-based community response projects (EB-CRPs) from cities. Guided by harm reduction principles, the Risk Environment Model, and Community/ Academic Partnerships (CAPs), in the UG3 we will: (1) Assess and enhance each county’s readiness to improve the local risk environment. (2) Examine the strengths, resources, needs, and gaps of each county’s risk environment. We will do so by conducting a multi-method Community Assessment of the Risk Environment that integrates innovative, rigorous epidemiology (e.g., mathematical modeling); policy assessment; and best practices in community-based research (e.g., CAPs). (3) Select a package of EB-CRPs that responds to local needs and strengths, using elements of Intervention Mapping. Go/no go milestones: Each county CAP has (1) established epidemiologic need for EB-CRPs; and (2) selected >1 EB-CRP targeting IDU NMPO/heroin misuse, OD, HCV, and HIV. In the UH3, we will: (4) Tailor selected EB-CRPs to each county’s context using the ADAPT-ITT framework. (5) Analyze the effectiveness and cost-effectiveness of each county’s EB-CRP package, using an innovative stepped-wedge randomized community trial design and mathematical models. We will use continuous quality improvement to enhance each EB-CRP’s fidelity, reach, immediate effects, and outcomes. We will draw strength from our collaborations. CAPs will integrate community members’ local knowledge with researchers’ scientific expertise. Multi-PIs Young and Cooper have assembled an academic team with unsurpassed expertise in key substance, methods, and theories, and in leading multi-site studies. The combination of a rigorous, innovative design (e.g., stepped-wedge community trials), strong theoretical frameworks, and a stellar team with community roots will ensure high impact in these vulnerable counties
StatusFinished
Effective start/end date8/15/177/31/18

Funding

  • National Institute on Drug Abuse: $593,958.00

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