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的“自然实验”机会，评估新的注射器获取法，参议院法案41 （SB41）在加州中央山谷内陆县的实施情况。中央谷地南部各县的注射毒品使用率是美国最高的，这在很大程度上导致了该地区的艾滋病流行。SB41法案于2012年1月1日生效，允许药店在没有处方的情况下销售多达30支注射器。尽管这项法律有可能极大地扩大注射器在加州内陆农村和拉丁裔县的使用范围，到目前为止，其他注射器使用计划严重不足，但法律规定的注射器销售是自愿的，目前尚不清楚药房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)评估药房对这项新的非处方（OTC）注射器法的实施情况，(2)描述注射吸毒者（IDU）在法律下对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（Fresno）和克恩（Kern）两个县进行，采用三阶段方法处理艾滋病毒“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）、简短的药房调查（N=596）和关键线人访谈（N=32），以评估药店对法律的执行情况，并描述相关障碍和促进因素。在第二阶段，我们将进行一项IDU调查（N=550），以了解法律下OTC注射器购买的IDU吸收情况，并确定相关障碍和促进因素。在第三阶段，我们将进行地理空间/上下文建模，以补充第一和第二阶段的发现，并阐明影响SB41影响的结构因素。在我们的研究结束时，我们将对促进和阻碍SB41成功作为艾滋病毒预防工具的因素有一个全面的了解。这些信息将有助于加州内陆社区制定多层次战略，以优化OTC注射器销售，减少注射器共用，并预防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.