OBJECTIVE: To evaluate the effectiveness and implementation of a multicomponent intervention to address the burden of drug use–related infectious diseases and overdose in rural settings.
DESIGN: Single-arm hybrid implementation-effectiveness design.
SETTING: Rural area comprising the Illinois counties of the Delta Regional Authority. PARTICIPANTS: People who use opioids and/or stimulants nonmedically.
INTERVENTION: Expansion of community-based harm reduction services, capacity-building for opioid use disorder and hepatitis C treatment.
MAIN OUTCOME MEASURES: Harm reduction service expansion intervention Reach, Effectiveness (injection equipment sharing), Adoption and Cost (per participant and budget impact analysis).
RESULTS: Three hundred six people who use drugs were enrolled. Of the 207 of who were not previously engaged in harm reduction services, 121 (59%) accepted referral and were retained in services at 6 months past study enrollment (intervention reach). In regards to intervention efficacy, among these individuals, 41 (35%) completed follow-up surveys; compared with their baseline self-report, there was a significant increase in obtaining sterile equipment from the harm reduction organization (43.9% vs. 68.3%, P = 0.03) and decrease in sharing injection equipment (46.3%–19.5%, P = .02). The harm reduction organization experienced an increase of approximately 100–550 program participants and an increase in service delivery area coverage from 1258 to 5509 square miles after intervention implementation (adoption). Cost per participant served by the harm reduction organization was $1486 per year, with annual budget impact to the program of $817 295. In regards to treatment capacity building, a total of 80 providers in the study area completed training in opioid use and/or hepatitis C management.
CONCLUSION: The pragmatic evaluation of harm reduction service expansion supported by a suite of implementation strategies serves to inform the practical considerations and decision-making by community-based organizations seeking to increase services in rural areas heavily affected by substance use, overdose, and related infectious diseases.
Implementation evaluation of a multicomponent intervention to address the infectious disease and overdose syndemic among people who use drugs in rural settings
Journal of Public Health Management and Practice [Epub 2026 Jul 6]. doi: 10.1097/PHH.0000000000002413.