EPIDEMIOLOGY OF US SYRINGE EXCHANGE PARTICIPANTS

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DESCRIPTION: (Applicant's Abstract) Program Announcement #94 0077 "Survey Research on Drug Use and Associated Behaviors" from the NIDA Division of Epidemiology and Prevention Research calls for innovative research to improve survey methods for assessing drug use behaviors in the U.S. Though politically controversial, syringe exchange (SE) programs are increasingly being used as a community based intervention to reduce HIV transmission among injecting drug users in the U.S. The number of U.S. SEs has increased from 33 to 88 in the last two years. Systematic surveys for SE participants could contribute greatly to the epidemiology of both injecting drug use and risk for HIV infection in the nation. We will conduct methodological research to lay a foundation for such systematic surveys. Potential underreporting of HIV risk behavior is perhaps the most critical aspect of future surveys of SE participants. Preliminary data suggest that SE program staff can collect data without high underreporting, and that audio computer-assisted structured interviewing (CASI) can reduce underreporting. In a 2x2 factorial design with random assignment of subjects to data collection conditions, we will compare potential underreporting of risk behavior in 1) face-to-face interviews conducted by independent researchers; 2) face-to-face interviews conducted by SE program staff; 3) in audio CASI interviews administered by independent researchers; and 4) in audio CASI interviews administered by SE program staff. Data on changes in HIV risk behavior and on current levels of HIV risk behavior will be obtained from 800 subjects from 4 different SE programs. In addition to the rapid growth in SE programs in the U.S., substantial organizational change is also occurring among individual programs. We will conduct two annual surveys of all identifiable SE programs in the U.S. Cluster analysis will be used to identify basic "types" of SE programs and changes in U.S. SE programs over time. We will produce annual "state-of-the-art" reports of SE programs in the country. These organizational studies will both provide the context for interpreting epidemiologic data collected from SE participants and provide needed information for developing sampling strategies for future national surveys of participants. From our previous experience in SE research and from the experience in this proposal, we will prepare a "state-of-the-art" monograph on collecting epidemiologic data from SE participants. The monograph will also address collecting biological samples from SE participants for potential HIV and hepatitis testing.