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

描述（由申请人提供）：本研究将利用艾滋病毒预防“自然实验”的机会，评估加州中央谷内陆县实施新的注射器获取法，参议院法案41（SB 41）。中央谷南部各县的注射毒品使用率是美国最高的，对该地区的艾滋病毒流行有很大的影响。SB 41于2012年1月1日生效，允许药店在没有处方的情况下出售多达30支注射器。尽管该法律有可能大大扩大加州内陆主要是农村和拉丁裔县的注射器获取，但到目前为止，其他注射器获取计划的服务严重不足，但根据该法律的注射器销售是自愿的，目前还不清楚药店将在多大程度上参与。我们的研究将使用创新的混合方法来（1）评估药房实施这项新的非处方（OTC）注射器法，（2）根据法律规定，描述注射药物使用者（IDUs）使用OTC注射器销售的特征，以及3）检查与药房实施和IDU使用相关的结构因素。这项研究将在弗雷斯诺和克恩两个县进行，采用三阶段方法来解决艾滋病毒风险环境所有三个层次的因素。“在第一阶段，我们将进行注射器购买试验（N=298），简短的药房调查（N=596）和关键线人访谈（N=32），以评估药房对法律的执行情况，并描述相关的障碍和促进因素。在第二阶段，我们将进行一项IDU调查（N=550），以了解IDU根据法律购买OTC注射器的情况，并确定相关的障碍和促进因素。在第三阶段，我们将进行地理空间/背景建模，以补充第一阶段和第二阶段的发现，并阐明影响SB 41影响的结构因素。在我们的研究结束时，我们将产生一个全面的了解的因素，促进和阻碍SB 41的成功作为一种艾滋病毒预防工具。这些信息将帮助内陆加州社区制定多层次的战略，以优化OTC注射器销售，减少注射器共享，并防止注射吸毒者之间的艾滋病毒传播。

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.