Implementation Evaluation of a Multicomponent Intervention to Address the Infectious Disease and Overdose Syndemic...

Area of Science:

• Public Health
• Implementation Science
• Infectious Disease Epidemiology

Background:

• Rural areas face significant burdens from drug use-related infectious diseases and overdose.
• Access to harm reduction services is often limited in rural settings.
• Multicomponent interventions are needed to address these complex public health challenges.

Purpose of the Study:

• To evaluate the effectiveness and implementation of a multicomponent intervention aimed at reducing drug use-related infectious diseases and overdose in rural populations.
• To assess the reach, effectiveness, adoption, and cost of expanding community-based harm reduction services.

Main Methods:

• A single-arm hybrid implementation-effectiveness study design was employed.
• The intervention targeted people who use opioids and/or stimulants nonmedically in rural Illinois counties.
• Key components included expansion of harm reduction services and capacity-building for opioid use disorder and hepatitis C treatment.

Main Results:

• The intervention reached 121 individuals not previously engaged in harm reduction services, with 59% retained at 6 months.
• Among participants, sterile equipment acquisition increased significantly (68.3% vs. 43.9%), and injection equipment sharing decreased (19.5% vs. 46.3%).
• The harm reduction organization saw increased participants and service area coverage, with a cost of $1486 per participant annually. 80 providers completed training.

Conclusions:

• Pragmatic evaluation of harm reduction service expansion provides valuable insights for community-based organizations in rural areas.
• Implementation strategies support increased service delivery for substance use, overdose, and infectious diseases.
• Findings inform practical considerations for decision-making in resource-limited settings.