Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
J Rural Health. 2020 Mar;36(2):208-216. doi: 10.1111/jrh.12409. Epub 2019 Nov 19.
To characterize how health care providers in western North Carolina (NC) manage patients with substance use disorders and to inform strategies for preventing injection drug use (IDU)-associated outbreaks of bloodborne infectious diseases.
We collected data on practice characteristics, provider sociodemographics, and attitudes and beliefs about hepatitis C virus (HCV), human immunodeficiency virus (HIV), opioid use, and IDU via online survey. Providers in 8 counties of western NC were invited to participate by email. Results were analyzed using descriptive and bivariate statistics.
Of 84 respondents participating between 30 July and 3 December 2018, 81% were practicing clinicians and 46% served a county identified as being vulnerable to IDU-associated outbreaks of HCV or HIV. A substantial proportion was unsure about injecting behaviors among patients. Scores reflected comfort working with opioid users, though this varied by medical specialty. One-quarter of respondents "never" discussed harm reduction or HCV treatment with patients known to inject drugs; 22% "never" discussed HIV screening with injectors; and 1 in 3 referred at-risk patients out for HCV or HIV testing rather than ordering a test themselves. Scores indicated low levels of stigma toward persons living with HCV or HIV. Respondents identified HIV treatment, HCV treatment, and liver disease management as training needs.
Our findings provide insights to inform health infrastructure improvement, with the goal of preventing HCV or HIV outbreaks in southern Appalachia. Rural health care workers are willing to receive additional training if it can improve care for patients affected by substance use disorders.
描述北卡罗来纳州西部（NC）的医疗保健提供者如何管理患有药物使用障碍的患者，并为预防与注射毒品使用（IDU）相关的血源性病原体传染病爆发提供策略。
我们通过在线调查收集了实践特征、提供者社会人口统计学以及对丙型肝炎病毒（HCV）、人类免疫缺陷病毒（HIV）、阿片类药物使用和 IDU 的态度和信念的数据。通过电子邮件邀请 NC 西部 8 个县的提供者参加。使用描述性和双变量统计分析对结果进行了分析。
在 2018 年 7 月 30 日至 12 月 3 日期间参与的 84 名受访者中，81%是执业临床医生，46%服务于一个被认为易受 IDU 相关 HCV 或 HIV 爆发影响的县。相当一部分人对患者的注射行为不确定。分数反映了与阿片类药物使用者合作的舒适度，尽管这因医疗专业而异。四分之一的受访者“从不”与已知注射毒品的患者讨论减少伤害或 HCV 治疗；22%“从不”与注射者讨论 HIV 筛查；三分之一的人将高危患者转诊进行 HCV 或 HIV 检测，而不是自己开检测单。分数表明对患有 HCV 或 HIV 的人的污名化程度较低。受访者确定 HIV 治疗、HCV 治疗和肝病管理是培训需求。
我们的研究结果为改善卫生基础设施提供了见解，旨在预防阿巴拉契亚南部的 HCV 或 HIV 爆发。如果能改善受药物使用障碍影响的患者的护理，农村卫生保健工作者愿意接受额外的培训。
