The Fayette County Health Department serves a rural WV population of just over 42,000. Fayette County has been particularly stricken by substance use disorder, leading to downstream increases in overdose and increases in infectious diseases, ranking 1st for rates of death due to drug overdose (81.4 per 100,000) in the United States. Fayette County had 208 reported EMS responses to overdose in 2022, primarily in remote outlying communities. WV has seen an alarming increase in HIV cases related to persons who inject drugs, with our adjacent county (Kanawha) being named most at risk by the CDC, increasing by over 300% in 2021. In 2017, the CDC ranked Fayette County #27th at risk for having an HIV outbreak. Fayette County is currently seeing a syphilis cluster, tripling in cases in 2022.
The Fayette County Health Department opened the doors to its Harm Reduction Program with syringe services in October of 2017 in response the overdoses and infectious disease threats in Fayetteville, WV. Uptake at the fixed site for participants was noted to decrease during the COVID-19 pandemic. With increased transportation barriers, increased financial strains due to inflation and COVID-19, increasing overdoses in remote locations in Fayette County, and the noted increases in infectious diseases surrounding Fayette County (Hepatitis, HIV, and syphilis), the decision was made to pursue mobile outreach for Harm Reduction Services. This would replicate the current fixed site, offering overdose education and naloxone distribution, sterile supplies including syringes, offering PrEP for HIV, testing and treatment for STIs, safe injection practices, fentanyl test strip delivery, rapid HIV and hepatitis testing and connection to care, vaccinations, wound care, primary care, family planning services, referral for treatment, and connection to needed local services to address social determinants of health. After advisement by persons who use drugs and our advisory council, as well as discussions and support from local jurisdictions (as required by WV Legislation), we launched our Mobile services in 2022. Our goal was to increase touchpoints in our community and enhance remote service offering at our two new locations, specifically distribution of naloxone, fentanyl test strips, and testing for HIV. 94 visits were added in the first 3 months of mobile programming.
Having a peer led program with diverse lived experience along with strong community partnerships has been integral to the success of the program, enhancing uptake in these remote communities and facilitating dispersement of services. By "meeting people where they are", and eliminating barriers, we have been able to increase both measures of naloxone distribution, fentanyl test strip use, and HIV testing. This has also enhanced other services in the specific communities, such as treatment for Hepatitis C, enhanced behavioral health services, and improved access to food and financial supports through building of those local programs. We have connected with new participants that we had not reached with our fixed site, allowing them services they desired, but were unable to obtain. An example of this was observed at a mobile site, when participants organized a barbeque for the community while we were providing services to show their gratitude. They were moved to tears that we came to their "holler".
Another marker of success comes from the requests of other communities to bring harm reduction services there. When local law enforcement and local governments reach out for these supports, it emphasizes the impact that mobile outreach provides, and highlights the needs of this vulnerable, marginalized population. We are balancing our growth as we are seeing more participant touch points as well as providing more supplies, which requires more financial support and infrastructure to maintain. Having local services in these remote communities further empowers them to be part of the solution and continue to create opportunities for change.
By adequately addressing the social determinants of health and removing barriers for care, we are able to enhance the health and wellbeing of outlying communities in our marginalized populations. By providing these services, participants are taking steps to reduce chaotic drug use as well as utilizing naloxone and fentanyl test strips to reduce overdose in these communities. Persons who use drugs as well as the communities that they live are rallying around creating a healthier life.
The Fayette County Health Department Harm Reduction Program is committed to continue to grow this life-saving, critical public health service, despite challenges it may face. Our participants remind us of this with each encounter.
www.fayettehealth.org