Changing Policy to Change Lives

University of North Carolina at Chapel Hill

HBEH 730: Theoretical Foundations of Behavioral & Social Science, Fall 2015

Shauna Ayres, Bridget Hochwalt, Tom Joseph, & Elizabeth Orlan

West Virginia experienced a

increase in Hepatitis C

rates between 2006-2012

73%

27%

Primary Risk Factors

Injection Drug Use

Other

0.7

3.1

0

0.5

1

1.5

2

2.5

3

3.5

USA WV

per

100,0

00 p

eople

Hepatitis C Rates

The Road to Addiction and Disease

1996

2000

INTRODUCTION Policy Campaign Program Timeline Summary

INTRODUCTION Policy Campaign Program Timeline Summary

Rates of Acute Hep. C per 100,000 residents

2007

2014

INTRODUCTION Policy Campaign Program Timeline Summary

HARM REDUCTION

POLICY

West Virginia Legislature

PROGRAM

Injection Drug Users

Dua

l A

ppro

ach

Introduction POLICY Campaign Program Timeline Summary

Proposed Bill for West Virginia

•County mandated & appropriated Needle Exchange Programs

• Surveillance for Hepatitis C

• Needle disposal

• Addiction treatment

• Naloxone & Suboxone

• Good Samaritan Law

• Evidence-based education added to school curriculum

Introduction POLICY Campaign Program Timeline Summary

BILL SPONSOR,

Delegate

Dr. Chris

Stansbury

of Kanawha

County

NEPs by State

• Kentucky SB 192 is a comprehensive harm reduction package

Prevention

• Good Samaritan

• NEP

• Education

Treatment

• Naloxone

• Suboxone

• Counseling

32 STATES+ District of Columbia & Puerto Rico

Introduction POLICY Campaign Program Timeline Summary

Evidence

Introduction POLICY Campaign Program Timeline Summary

Cost

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

$160,000

1 HCV Tx 1 NEP

Introduction POLICY Campaign Program Timeline Summary

Cabell County NEP Pilot Program

SUCCESSES

Community acceptance

8 other counties are interested

Started September 2015

Free needle exchange program

with educational components, counseling, & testing

Serving 305 individuals,

21-35 years old, 60% males

Goal: 1-1 exchange

LIMITATIONSBudget

Meeting demandTransportation

Introduction POLICY Campaign Program Timeline Summary

Passing HB

1001

Federal Gov.

Legislature

State & Local Gov.

Civil Society

Media

Constituents

Sta

keho

lder

Ma

pp

ing

Introduction POLICY Campaign Program Timeline Summary

Crushing the Competition

Allies Coalition Opponents

Introduction POLICY Campaign Program Timeline Summary

BILL SPONSOR,

Del. Chris Stansbury

House

Speaker

Tim

Armstead

Rep.

Hal

Rogers

(R-KY)

Patrick

Morrissey-

AG

Sen.

Joe

Manchin

(D-WV)

Gov.

Earl Ray

Tomblin

Sen.

Shelley

Capito

(R-WV)

Diffusion of Innovations

ConfirmationImplementationDecisionPersuasionAwareness

Introduction Policy CAMPAIGN Program Timeline Summary

Media Advocacy

Local PegInjustice

Introduction Policy CAMPAIGN Program Timeline Summary

“…It is literally touching every

community around this state…

If you don’t think it’s your problem now,

it soon will be.”

--Delegate Dr. Chris Stansbury of Kanawha County & BILL SPONSOR

Introduction Policy CAMPAIGN Program Timeline Summary

Driving the Conversation

Introduction Policy CAMPAIGN Program Timeline Summary

Access to Accurate Information

Introduction Policy CAMPAIGN Program Timeline Summary

Fact Sheet

Introduction Policy CAMPAIGN Program Timeline Summary

HARM REDUCTION

POLICY

West Virginia Legislature

PROGRAM

Injection Drug Users

Dua

l A

ppro

ach

Introduction Policy Campaign PROGRAM Timeline Summary

Program Summary

• County-Wide

• Individualized Service Delivery

• Suite of Services• Needle disposal

• Addiction treatment

• Infectious disease testing

• Harm reduction education

• Naloxone & Suboxone

Introduction Policy Campaign PROGRAM Timeline Summary

Social Networks

Homophily Centrality Reciprocity

Introduction Policy Campaign PROGRAM Timeline Summary

Word of Mouth

Most Cabell County’s NEP patrons are referred by word of mouth.

Introduction Policy Campaign PROGRAM Timeline Summary

Mobile AppHomophily

Centrality

Reciprocity

Mob

ile A

pp

Homophily

Centrality

Reciprocity

Introduction Policy Campaign PROGRAM Timeline Summary

Outcome Evaluation

Introduction Policy Campaign PROGRAM Timeline Summary

NEP

State PolicyNEP

↓Use of

dirty needles among IDUs

↓Use of

dirty needles among IDUs’

peers

↓Hep C &

other infectious diseases

HARM REDUCTION

Educational Material

& Resources

Testing & Treatment

Timeline

Introduction Policy Campaign Program TIMELINE Summary

NEEDLE EXCHANGE PROGRAM

Take Home Points

• Hepatitis C is an immediate & growing public health threat

Lack of funding from government

• Strong evidence that NEPs are a solution

• Clear cost-benefit

• Widespread community support

Introduction Policy Campaign Program Timeline SUMMARY

NEEDLE EXCHANGE PROGRAMS SAVE LIVES

Dr. Donna Evon Dr. Kurt Ribisl

Claire Brennan Dirk Davis

Tim Hazelett, Cabell County Health Administrator

Dr. Michael Kilkenny, Cabell County Health Director

Philip McDaniel, GIS Librarian, UNC-CH

Daniel Raymond, Policy Director, Harm Reduction Coalition, NYC

Looking Glass Café

Thank You!

“We hope to put ourselves out of business in the Harm Reduction Program.”

-Tim Hazelett, Cabell County Health Administrator

Mobile AppW

ork

s C

ited

Mobile AppW

ork

s C

ited