权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Post exposure prophylaxis among IDU syringe customers-Pharmacy pilot intervention

IDU 注射器顾客的暴露后预防——药房试点干预

基本信息

批准号：
8513957
负责人：
CRYSTAL FULLER LEWIS
金额：
$ 63.31万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-09-01 至 2015-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8513957
关键词：
AIDS prevention AIDS/HIV problem Accounting Acquired Immunodeficiency Syndrome Address Adherence Adverse effects Attitude Behavior Behavioral Caring Centers for Disease Control and Prevention (U.S.)Characteristics Cities Clinical Communities Counseling Data Diagnosis Disease Drug usage Education Educational Materials Effectiveness Enrollment Ethics Event Exposure to Goals HIV HIV Infections HIV Seropositivity HIV risk Health Personnel Health Services Health Services Accessibility Healthcare Hispanics Injecting drug user Injection of therapeutic agent Intervention Interview Knowledge Low income Medical Mind Modeling Needle Sharing Needle-Exchange Programs Needlestick Injuries Neighborhoods New York New York City Newly Diagnosed Occupational Participant Perception Persons Pharmaceutical Services Pharmacists Pharmacy facility Phase Prevalence Prevention approach Prevention strategy Printing Probability Prophylactic treatment Protocols documentation Public Health Randomized Controlled Trials Recommendation Regimen Reporting Research Research Personnel Risk Risk Behaviors Risk Reduction Sales Services Shares syringes Site Social Network Source Sterility Structure Subgroup Surveys Syringes Target Populations Techniques Testing Time Toxic effect United States Dept. of Health and Human Services Unsafe Sex Visit antiretroviral therapy base case-by-case basis community burden demographics design eligible participant experience follow-up high risk high risk behavior informant innovation men who have sex with men peer prevent prevention service programs public health relevance sex sex risk standard of care success transmission process

项目摘要

DESCRIPTION (provided by applicant): The purpose of this research is to evaluate a structural pilot intervention which aims to expand pharmacy services to include provision of non-occupational HIV post exposure prophylaxis (nPEP) and risk reduction information to injection drug users (IDUs) who buy syringes at two pharmacies registered with the New York State Expanded Syringe Access Program (ESAP), a program allowing pharmacies to sell syringes without a prescription to help reduce the spread of HIV among IDUs. PEP is the standard of care for health care workers who experience an accidental needle stick. The probability of HIV transmission in IDUs through sharing syringes is either similar to or higher than the risk of an occupational needle stick, which supports the use of nPEP in these cases. There is a preponderance of data supporting PEP (i.e., antiretroviral therapy) as an effective strategy to prevent HIV infection. Thus, PEP is recommended by the U.S. Department of Health and Human Services in non-occupational cases (exposure via high risk sex or injection behavior) when the exposure source is HIV positive or when the source is unknown but from a HIV prevalent community (e15%). ESAP's success creates a new window of opportunity to offer nPEP as a medically-based HIV prevention approach to low-risk IDUs such as ESAP participants who mostly access sterile syringes but may have an unplanned exposure. By targeting pharmacies in low-income, black and Hispanic communities where HIV burden is highest, a pharmacy-based nPEP program has the potential to create a more comprehensive HIV prevention plan that addresses the long-standing problem of racial disparities in HIV/AIDS. Thus, we aim to qualitatively and quantitatively evaluate a pharmacy-based nPEP program by comparing IDU syringe customers who would agree to pharmacy-based nPEP vs. those who would decline (in the event of an accidental exposure) with respect to demographics, risk behaviors, perceptions of health care access/needs among IDU syringe customers. Using a pre/post design targeted to syringe customers and their peers we will determine if IDUs/peers who receive nPEP information and risk reduction counseling are more likely to 1) have increased and accurate knowledge of nPEP as an HIV prevention strategy (over time), and 2) more frequently share accurate information about nPEP, risk reduction, and HIV prevention with peers (over time) with respect to baseline demographics, risk behavior, and healthcare needs and access (Aim 2). Among those request nPEP and eligible (i.e., low injection/sex risk IDUs) we will assess side effects and nPEP adherence, risk behavior, social networks, and attitudes and opinions about nPEP via clinical follow up. We will conduct key- informant interviews among key stakeholders (n=15) and enroll IDU syringe customers (and referred peers) from pharmacies providing nPEP information/risk reduction counseling via print materials and video followed by a baseline A-CASI survey (n=638). A peer-driven intervention component will facilitate recruitment and dissemination of nPEP information. Participants will return in 3-months to assess behavior, knowledge, and spread of nPEP information. Analysis will include standard qualitative and quantitative regression techniques.

描述（申请人提供）：本研究的目的是评估一项结构性试点干预措施，旨在扩大药房服务，包括向在纽约州扩大注射器获取计划（ESAP）注册的两家药房购买注射器的注射吸毒者（IDUs）提供非职业性艾滋病毒暴露后预防（nPEP）和降低风险的信息，一项允许药店出售无处方注射器的计划，以帮助减少艾滋病毒在注射吸毒者中的传播。PEP是医护人员遇到意外针刺时的护理标准。注射吸毒者通过共用注射器传播艾滋病毒的可能性与职业性针头刺伤的风险相似或更高，这支持在这些情况下使用nPEP。有大量数据支持PEP（即，抗逆转录病毒疗法）作为预防艾滋病毒感染的有效策略。因此，美国卫生与公众服务部建议在非职业病例（通过高风险性行为或注射行为暴露）中，当暴露源为HIV阳性或来源未知但来自HIV流行社区时（e15%），使用PEP。ESAP的成功创造了一个新的机会窗口，为低风险注射吸毒者提供nPEP作为一种基于医学的艾滋病毒预防方法，如ESAP参与者，他们大多使用无菌注射器，但可能有计划外的暴露。通过针对艾滋病毒负担最高的低收入，黑人和西班牙裔社区的药店，基于药店的nPEP计划有可能创建一个更全面的艾滋病毒预防计划，解决长期存在的艾滋病毒/艾滋病种族差异问题。因此，我们的目标是通过比较同意基于药店的nPEP的注射器客户与拒绝（在意外暴露的情况下）的注射器客户在人口统计学、风险行为、对注射器客户的医疗保健访问/需求的看法方面，定性和定量地评价基于药店的nPEP计划。使用针对注射器客户及其同龄人的前/后设计，我们将确定接受nPEP信息和风险降低咨询的IDUs/同龄人是否更有可能1）增加和准确了解nPEP作为艾滋病毒预防策略（随着时间的推移），以及2）更频繁地与同伴分享有关nPEP、风险降低和艾滋病毒预防的准确信息（随着时间的推移）关于基线人口统计学，风险行为，医疗保健需求和访问（目标2）。在那些要求nPEP和合格的（即，低注射/性风险IDUs），我们将通过临床随访评估副作用和nPEP依从性、风险行为、社交网络以及对nPEP的态度和意见。我们将在关键利益相关者（n=15）中进行关键知情人访谈，并从通过印刷材料和视频提供nPEP信息/风险降低咨询的药房招募IDU注射器客户（和推荐的同行），然后进行基线A-CASI调查（n=638）。同行驱动的干预部分将促进nPEP信息的招募和传播。参与者将在3个月内返回，以评估行为，知识和nPEP信息的传播。分析将包括标准的定性和定量回归技术。