OTC Syringe Sales to Prevent HIV in Underserved Areas of Inland California

描述(申请人提供)：这项研究将利用在艾滋病毒预防方面的“自然实验”的机会，评估新的注射器获取法-参议院法案41(SB41)-在加利福尼亚州中央山谷内陆县的实施情况。中央山谷南部县的注射吸毒率是美国最高的县之一，对该地区的艾滋病毒流行起到了重要作用。SB41于2012年1月1日生效，允许药店在没有处方的情况下销售最多30支注射器。尽管这项法律有可能极大地扩大加州内陆地区以农村和拉丁裔为主的县获得注射器的机会，到目前为止，其他获得注射器的项目对这些县的服务严重不足，但根据该法律进行的注射器销售是自愿的，目前尚不清楚药店将在多大程度上参与。我们的研究将使用一种创新的混合方法来(1)评估这项新的非处方药(OTC)注射器法的药房实施情况，(2)描述该法下注射吸毒者(IDU)对OTC注射器销售的使用情况，以及3)检查与药房实施和IDU使用相关的结构性因素。这项研究将在弗雷斯诺和克恩两个县进行，采用三个阶段的方法来解决艾滋病毒“风险环境”的所有三个层面的因素。在第一阶段，我们将进行注射器购买试验(N=298)、简要药房调查(N=596)和关键线人访谈(N=32)，以评估药店执行法律的情况，并确定相关障碍和促进者的特征。在第二阶段，我们将进行注射吸毒者调查(N=550)，以了解注射吸毒者依法购买非处方药注射器的情况，并确定相关障碍和促进者。在第三阶段，我们将进行地理空间/背景模拟，以补充第一和第二阶段的研究结果，并阐明影响SB41的S影响的结构性因素。在我们的研究结束时，我们将对SB41的S作为艾滋病毒预防工具成功的促进和阻碍因素有一个全面的理解。这些信息将帮助加利福尼亚州内陆社区制定多层次战略，以优化非处方药注射器的销售，减少注射器共用，并防止艾滋病毒在注射吸毒者中传播。

DESCRIPTION (provided by applicant): This study will capitalize on the opportunity for a "natural experiment" in HIV prevention to assess the implementation of a new syringe access law, Senate Bill 41 (SB41), in the inland counties of California's Central Valley. Injection drug use rates in the Central Valley's southern counties are among the highest in the U.S. and contribute substantially to the region's HIV epidemic. SB41, which went into effect on January 1, 2012, allows pharmacies to sell up to 30 syringes without a prescription. Although the law has the potential to greatly expand syringe access in inland California's predominantly rural and Latino counties, which have thus far been greatly underserved by other syringe access programs, syringe sales under the law are voluntary and it is unclear to what extent pharmacies will participate. Our study will use an innovative mixed methods approach to (1) assess pharmacy implementation of this new over-the counter (OTC) syringe law, (2) characterize utilization of OTC syringe sales by injection drug users (IDUs) under the law, and 3) examine structural factors associated with both pharmacy implementation and IDU utilization. The study will be conducted in two counties, Fresno and Kern, using a three-phase approach to address factors at all three levels of the HIV "risk environment." In Phase I, we will conduct a syringe purchase trial (N=298), a brief pharmacy survey (N=596), and key informant interviews (N=32) to assess pharmacies' implementation of the law and characterize related barriers and facilitators. In Phase II, we will conduct an IDU survey (N=550) to understand IDU uptake of OTC syringe purchase under the law and identify related barriers and facilitators. In Phase III, we will conduct geospatial/contextual modeling to complement findings from Phases I & II and elucidate structural factors that influence SB41's impact. At the conclusion of our study, we will have generated a comprehensive understanding of the factors that facilitate and impede SB41's success as an HIV prevention tool. This information will assist the communities of inland California in developing multi-level strategies to optimize OTC syringe sales, reduce syringe sharing, and prevent HIV transmission among IDUs.