Targeting Rural and Underserved Communities

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1 Targeting Rural and Underserved Communities University of Kentucky Board of Trustees Retreat October 18, 2018 April Young, PhD, MPH Associate Professor, Department of Epidemiology UK Center on Drug and Alcohol Research

2 National Rural Opioid Initiative Established through call for proposals in October 2016 Co-funded by National Institute on Drug Abuse (NIDA), Centers for Disease Control and Prevention (CDC), Substance Abuse and Mental Health Services Administration (SAMHSA), and the Appalachian Regional Commission (ARC) Funded eight sites in August 2017 Counties funded by the Rural Opioid Initiative

3 Rural Opioid Initiative in Kentucky Kentucky Communities and Researchers Engaging to Halt the Opioid Epidemic (CARE2HOPE) Led by April Young (UK) and Hannah Cooper (Emory University) Many academic and state partners CARE2HOPE Field Offices Gateway Health District Kentucky River Health District Appalachia

4 CARE2HOPE Design & Needs Phase 1 (August 2017 August 2019) $1.16 million Stakeholder Interviews with interviews community leaders Interviews, surveys, with people and who testing use with drugs people who Surveys use drugs with people who use drugs Community coalitions and and community activities Analysis of hepatitis C transmission networks Policy analysis County profiles using state data Phase 2 (September 2019 August 2022) Estimated $3.25 million Coalitions choose interventions are tailored to context Stepped wedge trial Counties Year 1 Year 2 Year 3 Counties 1-3 Counties 4-6 Counties 7-9

5 Interviews with Community Leaders In-depth interviews and readiness surveys with 76 stakeholders Participants included elected officials, law enforcement, health personnel, substance use treatment providers, pharmacists, people in recovery from substance use, faith leaders, and business leaders Community Knowledge of Overdose Community Knowledge of HIV 6 Initiation At least some community members know some about causes, consequences, signs, and symptoms 2 Denial/Resistance Only a few members have any knowledge about the issue & Needs

6 Interviews with People who use Drugs In-depth interviews with 32 people who use drugs Audio-recorded Asked about how they began using drugs, current drug use behaviors, and access to services I know a couple of my friends that share needles. They don t care at all They think [HCV infection is] inevitable. Like I do So no point in going the extra mile. When I first started, I [used a sterile syringe]. But then, after like a week, I was like screw this. Both my cousins have [hepatitis C]. All three of my cousins have it. My uncle has it. My mom s probably got it. I ve got it. & Needs

7 Surveys with People who use Drugs Surveys with 219 people who use drugs Testing for HIV, Hepatitis C, and syphilis Linkage to community resources Follow-up every 6 months Preliminary Findings 65% Hepatitis C antibody positive 50% overdosed in their lifetime 70% know someone who has died from an overdose 29 people (13%) had ever been prescribed naloxone; 21 of them had used it on someone to reverse an overdose & Needs

8 Enhancing Community Nine communityacademic partnership (CAP) groups (i.e., coalitions) have been established in each county/county cluster CAPs involve 72 total stakeholders Enhance community readiness for evidence-based interventions & Needs

9 Acknowledgments Funding: Studies were funded by NIDA, CDC, SAMHSA, and the ARC (UG3 DA044798; PIs: Young and Cooper) and NIDA (R21 DA042727; PIs: Cooper and Young). Project staff: Beth Lawson, Travis Green, Cindy Jolly, Roscoe Stamper, Connor VanMeter, Ryan Adams, Ashley Combs, April Ballard Colleagues: Hannah Cooper, Jennifer Havens, Sharon Walsh, Michelle Lofwall, Michele Staton, Carrie Oser, Shanna Babalonis, Michelle Kegler, Kelli Komro, Alex Wagenaar, Regine Haardorfer, David Cloud, Ralph DiClemente, Abby Rudolph State Partners: Ardis Hoven, Katie Marks, Sara Robeson, Kentucky Injury Prevention and Research Center, and others Participants and coalition members For more information, visit