Kentucky outreach service kiosk (KYOSK): reducing HIV, HCV, and overdose risk in rural appalachia through harm reduction kiosks

Active Project Grant Awarded Last action

Award ID
R01DA055872
Recipient
Awarding agency
Obligated
$5,181,530

Award facts

Assistance listing
93.279 Drug Use and Addiction Research Programs
Completion date 86% complete
Place of performance
Lexington, KY 40506, USA

Award details come from USAspending.gov.

Description

Abstract
The proposed project will test an innovative approach to reducing harms related to the epidemics of injection drug use, overdoses, hepatitis C (HCV), and to imminent HIV outbreaks, in rural appalachian kentucky which has long been an epicenter of these intertwined crises. Our research has shown that the region has high rates of HCV, overdose, injection drug use, condomless SEX, and dense risk networks that could kindle an HIV outbreak. Following a 2014 HIV outbreak in neighboring indiana and a national analysis of HIV/HCV outbreak vulnerability among people who inject drugs (PWID) revealing that 54 of kentucky's 120 counties ranked in the top 5% nationally, kentucky passed landmark legislation permitting counties to operate syringe service programs (SSPS). Despite an arduous county-level approval process, kentucky has succeeded in opening 80 SSPS, more than any other U.S. State. Unfortunately, this robust harm reduction infrastructure remains under- utilized in rural settings. Data from our research funded by nida's national rural opioid initiative revealed that nearly half of PWID had never used the existing staffed SSPS and, over 24 months of follow-up, SSP uptake remained low and program drop-out was not uncommon. The most frequent reason cited for having never used an SSP was fear of stigma. Evidence suggests that PWID in the region want a range of harm reduction service models, and among those who report stigma as a reason for not using the staffed SSPS, the most desired model is a vending machine, or 'kiosk'. Harm reduction kiosks have been operating globally for more than 30 years and research has demonstrated that they can expand syringe access. Yet very few kiosks operate in the U.S., and none operate in rural areas where they might be especially beneficial. Research suggests that kiosks might be a cost-effective way to expand syringe access when coupled with staffed SSPS but their implementation, impact, and cost-effectiveness have not been rigorously evaluated. In response, we propose a type 1 hybrid effectiveness trial to test the effectiveness, implementation outcomes, and cost effectiveness of a community-tailored, harm reduction kiosk in reducing HIV, hepatitis C, and overdose risk behavior in rural appalachia. Our kiosk, or kyosk (KY outreach service kiosk), will be supplied with injection equipment, naloxone, fentanyl test strips, hygiene kits, condoms, and other supplies as well as an innovative call-back feature for facilitated referral to needed services by trained recovery coaches. The kyosk will be tailored to the local context through a community-engaged process and a kiosk design team involving people who use drugs and local and state leaders. Interest in reduction kiosks is soaring nationwide and the proposed project would provide critical and timely data to inform scale-up of this model, especially in rural areas of the country that have been severely impacted by substance use related harms.

Transactions

Action Obligated Date
Amendment $79,470
Amendment Kentucky outreach service kiosk (KYOSK): addressing health needs and improving service linkage in rural appalachia through health kiosks - this project tests… $495,809
Amendment $25,877
Amendment $550,448
Amendment Kentucky outreach service kiosk (KYOSK): reducing overdose, hepatitis C, and other drug-related risks in rural appalachia through health kiosks - the proposed… $550,448
Amendment $582,295
Amendment $591,248
Amendment $591,248
Amendment $609,439
Original award $609,439

Subawards

Subrecipient Amount Awarded
Emory University The proposed study is a collaboration among the University of Kentucky (UK), the Rollins School of Public Health (RSPH) at Emory University, and other… $14,475
University Of Bristol Examine the impact and cost-effectiveness of a harm reduction kiosk using a dynamic, deterministic model of HCV transmission and overdose. $25,877
KY River District Health Department The proposed study is a collaboration between the University of Kentucky (UK) and the Perry County Health Department. Among other strengths, the project… $36,870
Emory University The proposed study is a collaboration among the University of Kentucky (UK), the Rollins School of Public Health (RSPH) at Emory University, and other… -$23,749

Quick answers

Who received award R01DA055872?

R01DA055872 was awarded to The University Of Kentucky Research Foundation by National Institute on Drug Abuse (National Institutes of Health) on August 15, 2022.

How much is award R01DA055872 worth?

$5,181,530 has been obligated on R01DA055872.

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