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

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

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

CARE2HOPE Design

Assess Community

Readiness & Needs

Select

Interventions

Tailor

Interventions

Conduct community

randomized trial

Enhance Community

Readiness

Phase 1

(August 2017 – August 2019)

$1.16 million

• Stakeholder interviews

• Interviews, surveys, and testing with people

who use drugs

• Community coalitions 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

• Interventions are tailored to context

• Stepped wedge trial

Assess Community

Readiness & Needs

Select

Interventions

Tailor

Interventions

Conduct community

randomized trial

Enhance Community

Readiness

Assess Community

Readiness & Needs

Select

Interventions

Tailor

Interventions

Conduct community

randomized trial

Enhance Community

Readiness

Counties Year 1 Year 2 Year 3

Counties 1-3

Counties 4-6

Counties 7-9

Phase 1

(August 2017 – August 2019)

$1.16 million

• Interviews with community leaders

• Interviews with people who use drugs

• Surveys with people who use drugs

• Community coalitions and community

activities

• Analysis of hepatitis C transmission networks

• Policy analysis

• County profiles using state data

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

Assess Community

Readiness & Needs

Select

Interventions

Tailor

Interventions

Conduct community

randomized trial

Enhance Community

Readiness

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

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

Assess Community

Readiness & Needs

Select

Interventions

Tailor

Interventions

Conduct community

randomized trial

Enhance Community

Readiness

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.

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

Assess Community

Readiness & Needs

Select

Interventions

Tailor

Interventions

Conduct community

randomized trial

Enhance Community

Readiness

Enhancing

Community Readiness

• Nine community-

academic 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

Assess Community

Readiness & Needs

Select

Interventions

Tailor

Interventions

Conduct community

randomized trial

Enhance Community

Readiness

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 www.care2hope.org