Journal Article

Kentucky Outreach Service Kiosk (KyOSK) Study protocol: a community-level, controlled quasi-experimental, type 1 hybrid effectiveness study to assess implementation, effectiveness and cost-effectiveness of a community-tailored harm reduction kiosk on HIV, HCV and overdose risk in rural Appalachia

Larimore, Elizabeth, Jahangir, Tasfia, Havens, Jennifer R, Knudsen, Hannah, Freeman, Edward, Young, April M, Design Team, KyOSK, Fanucchi, Laura, Vickerman, Peter, Community Staff, KyOSK, Fallin-Bennett, Amanda, Stone, Jack, Freeman, Patricia R, Livingston, Melvin D, White, Carol R, Cheatom, Chelsi, McCollister, Kathryn E, Cooper, Hannah L F

2024

Overview

IntroductionMany rural communities bear a disproportionate share of drug-related harms. Innovative harm reduction service models, such as vending machines or kiosks, can expand access to services that reduce drug-related harms. However, few kiosks operate in the USA, and their implementation, impact and cost-effectiveness have not been adequately evaluated in rural settings. This paper describes the Kentucky Outreach Service Kiosk (KyOSK) Study protocol to test the effectiveness, implementation outcomes and cost-effectiveness of a community-tailored, harm reduction kiosk in reducing HIV, hepatitis C and overdose risk in rural Appalachia.Methods and analysisKyOSK is a community-level, controlled quasi-experimental, non-randomised trial. KyOSK involves two cohorts of people who use drugs, one in an intervention county (n=425) and one in a control county (n=325). People who are 18 years or older, are community-dwelling residents in the target counties and have used drugs to get high in the past 6 months are eligible. The trial compares the effectiveness of a fixed-site, staffed syringe service programme (standard of care) with the standard of care supplemented with a kiosk. The kiosk will contain various harm reduction supplies accessible to participants upon valid code entry, allowing dispensing data to be linked to participant survey data. The kiosk will include a call-back feature that allows participants to select needed services and receive linkage-to-care services from a peer recovery coach. The cohorts complete follow-up surveys every 6 months for 36 months (three preceding kiosk implementation and four post-implementation). The study will test the effectiveness of the kiosk on reducing risk behaviours associated with overdose, HIV and hepatitis C, as well as implementation outcomes and cost-effectiveness.Ethics and disseminationThe University of Kentucky Institutional Review Board approved the protocol. Results will be disseminated in academic conferences and peer-reviewed journals, online and print media, and community meetings.Trial registration numberNCT05657106.

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Appalachian Region / Cost analysis / Cost-Benefit Analysis / Drug overdose / Drug Overdose - prevention & control / Drug use / Effectiveness studies / Harm Reduction / Hepacivirus / Hepatitis C / Hepatitis C - prevention & control / HIV / HIV Infections - prevention & control / Human immunodeficiency virus / Humans / Infections / INFECTIOUS DISEASES / Intervention / Kentucky / Narcotics / Non-Randomized Controlled Trials as Topic / Outreach services / Population / Public Health / Rural Population / Substance misuse / Violent crime