Learning from the COVID-19 pandemic to improve emergency management planning for harm reduction services in rural Ohio

PROJECT SUMMARYCOVID-19 has been devastating in many areas of the United States. Both the disease itself and the necessarymitigation measures have affected local communities. Local health departments have struggled to identifyways to continue to serve their communities. One population that has been affected in multiple ways is peoplewho inject drugs (PWID). In many rural areas, harm reduction services have been closed because of theresponse to COVID-19, isolating many PWID. Some health departments have noted the absence of a clearemergency response plan to continue serving the vulnerable PWID population. Building on our relationshipsthat we have established in our UG3/UH3 Rural Opioid Initiative project, referred to as the Ohio Opioid Project(OHOP), we will assess the impact of the COVID-19 pandemic on local stakeholders and PWID in southernOhio. We will then use this information to develop an emergency management plan for two local healthdepartments that provide the only syringe service programs in the area. This plan will form the basis of ageneralizable approach that can be used elsewhere in rural areas of the U.S. The aims for this supplement areto: Aim 1) Explore the impact of COVID-19 on PWID and harm reduction services to identify strengths andgaps in emergency preparedness in Scioto and Gallia Counties (Step 1, PHEPARC). Aim 2) Assess the impactof COVID-19 on overdose and infectious diseases among PWID (Step 1, PHEPARC) Aim 3) Develop anemergency management plan for harm reduction and treatment services for use in Ohio and other states. InAim 1, we will assess provider preparation, unanticipated and anticipated challenges, and the impact onservices in the immediate aftermath of the pandemic. We will conduct 30 in-depth interviews with PWID and 30in-depth interviews with substance use providers, first responders, and state and local emergency responseofficials. In Aim 2, we will explore PWID's experiences with stigma, injection networks, overdose, syringeaccess, and access to care for MOUD and other health care through our respondent-driven sampling (RDS)survey. In Aim 3, we will draw from Aim 1 and 2 findings and work closely with the Ohio governmentalagencies, local health departments, and our community advisory board to develop a flexible emergencyresponse plan that can address the unique needs of rural counties. The plan will include a decision structure,communication plan, and detailed guidelines for substance use providers to mitigate the impact of futurecrises. Upon completion of this supplement, we will have a clear understanding of the impact of the COVID-19pandemic on PWID and harm reduction support in rural Ohio. And we will provide a strategy to mitigate theimpact of future crises on the rural PWID population in the future.