# Promoting remote and secondary risk prevention services in rural settings

> **NIH NIH R01** · UNIVERSITY OF CHICAGO · 2024 · $166,670

## Abstract

ABSTRACT OF PARENT GRANT
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:** 11080100
- **Project number:** 3R01DA057665-01S1
- **Recipient organization:** UNIVERSITY OF CHICAGO
- **Principal Investigator:** MARY ELLEN MACKESY-AMITI
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $166,670
- **Award type:** 3
- **Project period:** 2022-09-30 → 2025-09-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11080100

## Citation

> US National Institutes of Health, RePORTER application 11080100, Promoting remote and secondary risk prevention services in rural settings (3R01DA057665-01S1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/11080100. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*