BACKGROUND: Emerging drug trends and associated risk behaviors often require a quicker response than more conventional public health methods allow. Rapid assessment and response (RAR) is a method that can address public health risk behaviors and associated consequences in real-time. Based on the traditional epidemiologic model of infectious disease outbreaks, RAR uses quantitative data to analyze current drug trends and trigger assessment. Although there are clear methods for conducting surveillance, surveillance frequently does not provide sufficient information to guide response. In this presentation, we will describe New York City’s assessment protocols and share case examples of results of assessment leading to response.
METHODS: Following a signal from syndromic or mortality data, the team develops a case definition and determines the population at risk. Prior to assessment, key informants are identified and information is ascertained from pre-specified groups/individuals. Depending on the drug of interest, assessment activities include: mapping services that drug users use in the area, qualitative interviews to understand drug users’ perspectives on the issue, and data collection on gaps in services. Responses vary for each assessment and could include the distribution of educational materials and naloxone.
RESULTS: Following an increase in fentanyl-involved fatal overdoses in the North Bronx, staff initiated the RAR protocol in Spring 2016. First, all neighborhood services were mapped. Key informant interviews conducted in the North Bronx neighborhood included: syringe exchange program (SEP) staff and participants, and drug treatment providers and participants. For this assessment, we also conducted a self-report survey with a convenience sample with drug treatment participants about their knowledge of naloxone. Main results of the assessment were that despite a large treatment program in the North Bronx, patients did not know about naloxone and programs did not make it available. Our response strategy included: distributing over 1200 naloxone kits to clients at methadone maintenance treatment programs in the North and Central Bronx, registering a neighborhood pharmacy to distribute naloxone under standing orders, and registering one outpatient treatment facility as an opioid overdose prevention program.
CONCLUSIONS: Timely access to data has led to greater imperative to use data in real-time. Our assessment protocol in the North Bronx led to implementation of neighborhood-specific responses. Given the success of the RAR in the North Bronx, DOHMH is expanding its RAR capacity in future investigations. We will share results of other RAR investigations and discuss ways that the RAR model can be used by other jurisdictions.