In the re-entry health linkage intervention, research staff will: 1) meet with participants in jail before they are released to ask them questions about drug use and related behaviors, access to needed health and social services, and personal goals; they will provide overdose education and help develop a plan for reducing risks and accessing services after release from jail; 2) meet with participants within one week of their release to conduct urine or saliva drug testing, offer HIV and hepatitis C testing and counseling, naloxon, and harm reduction supplies, and to connect participants with needed services; 3) follow up with participants once a month for three months to help participants overcome challenges; and 4) six months after release from jail, contact participants to conduct saliva or urine drug testing. Participants will complete surveys at pre-release, and at 1 week, 3 months and 6 months weeks post-release.

The investigators will initiate the comparison group in each county six months before the intervention begins. Research staff will conduct a pre-release overdose intervention with the comparison cohort. The comparison group participants will complete an interactive training with animated scenarios and narration on preventing, recognizing, and responding effectively to an opioid OD, accompanied by information about Kentucky's Good Samaritan Law and Naloxone Access Law. Research staff will answer questions after the video. Individuals will receive a Community Resource Guide at this visit. As in the intervention group, comparison group participants will complete surveys at pre-release, and at 1 week, 3 months and 6 months weeks post-release. Surveys will be identical to those delivered to the intervention cohort

Substance Use

HIV Infections

HCV Infection

Sexually Transmitted Infections (Not HIV or Hepatitis)

Overdose, Drug

Opioid Use

Research staff will: 1) help participants set goals and reduce their health risks by helping them to reflect on personal drug use, sexual relationships, and their consequences in the context of personal values and goals; 2) help link participants to services that they need and want; 3) offer participants the option of HIV and hepatitis C testing, provide the test result, and provide post-test counseling; and 4) provided participants nasal spray naloxone (Narcan) to carry with them in case they encounter someone who has an opioid overdose or in case they have an opioid overdose and a friend can use the naloxone to respond.

Re-entry Health Linkage

Participants will complete a 20-minute overdose education training (i.e.,an interactive training with animated scenarios and narration on preventing, recognizing, and responding effectively to an opioid OD).

Overdose Education

University of Kentucky

Kentucky Communities and Researchers Engaging to Halt the Opioid Epidemic (CARE2HOPE)

Kentucky Communities and Researchers Engaging to Halt the Opioid Epidemic (CARE2HOPE) - UH3 PHASE

Item:Self-reported frequency of substance use to get high in past 30 days (continuous variable)
Source: Rural opioid initiative (ROI Harmonized UG3 Survey) Harmonized UG3 Survey

Item: Self-reported recent (past 30 days) frequency of using a syringe that had been previously used by someone else (continuous; number and proportion)
Source: ROI Harmonized UG3 Survey

Item: Self-reported recent (past 30 days) frequency of condomless anal or vaginal sex (continuous; number and proportion)
Source: ROI Harmonized UG3 Survey

Item: Self-reported recent (past 30 days) frequency of shared cookers, cotton, spoon, or water (continuous; number and proportion)
Source: ROI Harmonized UG3 Survey

Item:Self-reported recent (past 90 days) number of times overdosed (ordinal, continuous)
Source: Modified from ROI Harmonized UG3 Survey

Item:Self-reported recent (past 30 days) frequency of using a syringe that had been previously used by someone else (continuous; number and proportion)
Source: ROI Harmonized UG3 Survey

Item: Self-reported recent (past 30 days) frequency of injection (ordinal, continuous)
Source: ROI Harmonized UG3 Survey

Item:Self-reported recent (past 90 days) number of days carrying naloxone (continuous)
Source: Modified from ROI Harmonized UG3 Survey

Item: Self-reported recent (past 90 days) engagement in evidence-based responses (i.e., called 911, gave naloxone, stayed until an ambulance or police arrived, transported person to the hospital) to a witnessed overdose by self or other bystanders (nominal)
Source: CDC NHBS Supplemental overdose items

Item:Self-reported recent (past 90 days) frequency of being on MOUD (continuous)
Source: Modified from ROI Harmonized UG3 Survey

Item:Self-reported recent (past 90 days) access to follow-up HCV RNA testing (nominal);
Source: ROI Harmonized UG3 Survey

Item: Self-reported recent (past 90 days) frequency of receiving treatment among those who test RNA positive (binary)
Source: Modified from ROI Harmonized UG3 Survey

Item: Self-reported proportion of recent (past 90 days) injections that involved a new, sterile syringe obtained from a syringe service program (continuous, proportion)
Source: ROI Harmonized UG3 Survey

Data from the University of Kentucky are required to be submitted to the University of Washington as part of the NIH-funded Rural Opioid Initiative (ROI) data harmonization project. The University of Washington Data Harmonization Coordinating Center will be harmonizing data across 8 ROI studies in order to create new, harmonized datasets to be used for analyses across the consortium. The University of Washington and other ROI grantees will perform data analyses on these data for peer-reviewed publication. The harmonized datasets will be provided to other ROI grantees as required for analysis and will be considered under the umbrella of mandated DCC activities. No third parties outside of the ROI will be given access to this harmonized data. Harmonized datasets will be built to specific project concept proposals, and all project proposals must be reviewed and approved by the ROI consortium's Publications Working Group before distribution of the customized dataset.

April M Young

Associate Professor, Department of Epidemiology

National Institute on Drug Abuse (NIDA)

Substance Abuse and Mental Health Services Administration (SAMHSA)

Emory University

Temple University

Stepped wedge community randomized trial. Each year, 4 counties will be randomized to start 6 months of enrollment into a control condition, followed by 6 months of enrollment into the intervention, with 6 months of follow-up data collection.

sorbus torminalis/hepatitis

Kentucky Communities and Researchers Engaging to Halt the Opioid Epidemic (CARE2HOPE)

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