Kentucky Outreach Service Kiosk (KyOSK): Reducing Overdose, Hepatitis C, and Other Drug-related Risks in Rural Appalachia through Health Kiosks

University Of Kentucky, Lexington KY

Investigators

Linked publications & trials

Abstract

The proposed project will test and evaluate the effectiveness of 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, 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 “substance abuse treatment outreach programs” that provide syringe services alongside other healthcare resources (hereafter, 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 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 reasons cited for having never used an SSP were related to fear of being “outed” as a person who uses drugs. Evidence suggests that PWID in the region want a range of service models, and among those who report fear of social and legal consequences as a reason for not using the staffed SSPs, the most desired model is a vending machine, or ‘kiosk’. 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 locally-tailored kiosk in reducing overdose, hepatitis C, and HIV risk behavior in rural Appalachia. Our kiosk, or KyOSK (KY Outreach Service Kiosk), will feature first-of-its-kind technology and will be supplied with injection equipment, naloxone, fentanyl testing kits, hygiene kits, and other supplies as well as an innovative call-back feature for facilitated referral to needed services (e.g., employment, education, treatment) by trained recovery coaches. The KyOSK will be tailored to the local context under the leadership of a Kiosk Design Team involving people who use drugs and local and state leaders. Interest in kiosks is soaring nationwide and the proposed project would provide critical and timely data to inform scale-up of this potentially cost effective model, especially in rural areas of the country that have been severely impacted by substance use related harms.