# Promoting remote harm reduction and secondary services in rural settings (PROMOTE) study

> **NIH NIH R01** · UNIVERSITY OF CHICAGO · 2022 · $2,405,743

## Abstract

PROJECT SUMMARY
Over the past two decades, rural counties in the U.S. have seen increasing rates of overdose death along with
rising hepatitis C incidence and outbreaks of HIV linked to injection drug use. The rural opioid crisis is co-
occurring and intertwined with evolving methamphetamine use and polysubstance use more broadly. The burden
of morbidity and mortality related to substance use in the rural setting is exacerbated by the scarcity of resources
such as addiction treatment, overdose education and naloxone distribution, syringe exchange, and other harm
reduction services (HRS). Given the lack of biomedical treatment for methamphetamine use disorder, efforts to
improve health outcomes for people who use methamphetamine hinge largely on harm reduction strategies. In
the face of the pandemic grassroots HRS organizations have been challenged to adapt service delivery amidst
sparse resources and shifting drug use behavior. The proposed study aims to understand evolving drug use and
harm reduction behavior in rural settings, including those where polysubstance use with methamphetamine and
fentanyl are prevalent, in order to inform the expansion of effective HRS within these communities. We will
engage HRS providers and participants in a process of tailoring strategies for remote, contactless delivery of
services, and evaluate their implementation. This study will explore individual, interpersonal, and community
influences on engagement in harm reduction according to the socio-ecological model. In Aim 1, we will assess
drug use, harm reduction behavior, and decision-making processes regarding harm reduction engagement and
use and distribution of supplies among people who use drugs (PWUD). We will collect data through multiple
methods including baseline surveys, two weeks of daily assessments using mobile phones, and semi-structured
interviews with PWUD accessing HRS. In Aim 2, using social network survey methods as well as in depth
qualitative interviews, we seek to understand the dynamics of secondary distribution by identifying the personal
and social network characteristics of participant champions who may implement network interventions. In Aim
3, we will develop and evaluate the implementation of remote harm reduction service delivery including digital
lock boxes and mail ordered supplies tailored to address structural barriers in rural settings. This process will
include needs assessment through key informant interviews, guided discussion groups forming a learning
community co-led by an HRS provider, and implementation and evaluation informed by the EPIS implementation
framework. This work will provide foundational knowledge to develop practical harm reduction delivery strategies
for rural areas facing disparate challenges in pandemic-era service provision as well as inform future network
interventions for rural drug use characterized by methamphetamine and the ubiquitous presence of synthetic
opioids.

## Key facts

- **NIH application ID:** 10590281
- **Project number:** 1R01DA057665-01
- **Recipient organization:** UNIVERSITY OF CHICAGO
- **Principal Investigator:** MARY ELLEN MACKESY-AMITI
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $2,405,743
- **Award type:** 1
- **Project period:** 2022-09-30 → 2025-09-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10590281

## Citation

> US National Institutes of Health, RePORTER application 10590281, Promoting remote harm reduction and secondary services in rural settings (PROMOTE) study (1R01DA057665-01). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10590281. Licensed CC0.

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