Development of Behavioral and Social Interventions that Reduce Stigma and Improve

描述（由申请人提供）：该申请涉及广泛的挑战领域（01）行为，行为改变和预防，以及具体的挑战主题，01- da -106：发展行为和社会干预措施，减少耻辱，提高低资源环境下卫生保健服务的质量和可及性。我们将评估一项以药品为基础的试点干预措施，该措施将快速艾滋病毒检测与其他预防性筛查服务（包括血压、血糖和胆固醇筛查）结合起来。该试点项目针对的是通过纽约州扩大注射器获取计划（ESAP）从药店购买注射器的注射吸毒者，该计划旨在增加无菌注射器的获取，以帮助减少艾滋病毒传播。通过将艾滋病毒检测与较少污名化的筛查服务结合起来，并向所有药房顾客提供检测而不是单独针对吸毒者，减少艾滋病毒检测和与吸毒有关的污名化的可能性将会增加。虽然艾滋病毒检测越来越容易获得，而且有新的检测技术，但黑人和西班牙裔社区的艾滋病毒检测率很低，特别是在有感染艾滋病毒和许多其他传染病和慢性病风险的注射吸毒者中。黑人和西班牙裔社区，特别是注射吸毒者的结构性障碍（即缺乏医疗保险）可能限制他们获得常规保健/预防服务。接受艾滋病毒检测带来的耻辱感可能会将个人确定为吸毒者和/或从事社会不可接受行为的人，这加剧了获取艾滋病毒的障碍。因此，本研究旨在1)定性地评估药房的HIV检测和慢性病筛查，2)比较/对比IDU注射器客户及其同龄人同意HIV检测与不同意HIV检测的相关性，以及3)定性地比较/对比具有综合筛查服务的HIV检测药房（干预）与仅进行HIV检测的药房（对照）。为了实现这些目标，我们建议在主要利益相关者之间进行深入访谈，为研究材料的开发提供信息，IDU/同行调查和药房员工调查。我们将招募2家在esap注册的哈莱姆药房（1家干预药房和1家对照药房），我们目前的工作已经在这些药房建立了开展现场筛查服务的基础设施。在干预对照药房中，将招募798个（518个非吸毒药房，70个吸毒药房+3个网络/吸毒药房）药房顾客。我们将调整以前开发的培训模块，培训药房人员如何吸引药房客户。干预药房的顾客将完成一份关于对艾滋病毒、注射药物和耻辱的态度的简短态度量表，观看关于健康检查（特别是艾滋病毒检测）重要性的教育视频，参加所需的筛查服务，并进行20分钟的结构化ACASI，重复态度量表。对照药房的顾客将只接受艾滋病毒检测和20分钟的结构化ACASI调查。将对所有药房员工进行半结构化调查，以确定现场预防服务对药房人员和业务流程的影响。我们将使用标准的定性分析技术和GEE来解释定量分析中的聚类。拟议的研究非常重要，因为它旨在探索一项试点干预措施，其中包括扩大药房服务，将艾滋病毒检测包括在内，并确定在一种综合预防方法中提供艾滋病毒检测，其中包括较少污名化的筛查测试（即血压、血糖和胆固醇筛查），是否能增加在药店购买注射器的注射吸毒者及其同龄人（吸毒和/或不吸毒）中的艾滋病毒检测。我们将使用新的艾滋病毒检测技术，并将技术创新和治疗方式引入纽约市的低收入社区。如果成功，这种模式不仅可以在纽约的其他高风险社区推广，还可以在其他几个城市和州推广。如果我们的发现是积极的，那么更广泛的公共卫生影响将随之而来。药剂师可以与临床医生和其他卫生保健提供者合作，向高风险注射吸毒人群和其他获得卫生保健服务机会有限的群体（如无保险和无证移民）提供综合艾滋病毒检测方法。还可以在更大范围内实施这种综合艾滋病毒检测方法，减少边缘化人群在获得艾滋病毒检测和污名化方面遇到的许多障碍，同时通过针对对边缘化人群造成不成比例影响的慢性病结果，增加和改善总体健康和福祉。

DESCRIPTION (provided by applicant): This application addresses the broad Challenge Area (01) Behavior, Behavioral Change, and Prevention and the specific Challenge Topic, 01-DA-106: Development of behavioral and social interventions that reduce stigma and improve quality and accessibility of health care services in low resource settings. We will evaluate a pharmacy-based pilot intervention that combines rapid HIV testing with other preventive screening services including blood pressure, glucose, and cholesterol screening. This pilot targeted to injection drug users (IDUs) who purchase syringes from pharmacies via the New York State Expanded Syringe Access Program (ESAP) - a program aimed at increasing sterile syringe access to help reduce HIV transmission. By combining HIV testing with less stigmatizing screening services and offering testing to all pharmacy patrons instead of singling out drug users, the likelihood of reducing HIV testing and drug use-associated stigma will increase. Although HIV testing is increasingly accessible and new testing technologies are available, HIV testing rates are low in the black and Hispanic community, especially among IDUs at risk for HIV and many other infectious and chronic diseases. Structural barriers (i.e., lack of health insurance) in the black and Hispanic community, especially among IDUs may limit access to regular health care/ preventive services. Access barriers are compounded by stigma associated with getting an HIV test that may identify an individual as a drug user and/or someone who engages in socially unacceptable behavior. Thus, this proposed study aims to 1) qualitatively evaluate HIV testing and chronic disease screening in pharmacies, 2) compare/contrast correlates of agreeing to a HIV test vs. not among IDU syringe customers and their peers and 3) qualitatively compare/contrast HIV testing with comprehensive screening services pharmacy (intervention) vs. HIV testing only pharmacy (control). To accomplish these aims, we propose to conduct in-depth interviews among key stakeholders to inform development of study materials, IDU/peer survey and pharmacy staff surveys. We will recruit 2 ESAP-registered Harlem pharmacies (1 intervention and 1 control) where our current work has developed the infrastructure to perform on-site screening services. Among the intervention and control pharmacies, 798 (518 non-drug using, 70 drug-using +3 networks/ drug user) pharmacy customers will be recruited. We will adapt a previously developed training module to train pharmacy personnel on how to engage pharmacy customers. Customers from the intervention pharmacy will complete a brief attitude scale on attitudes toward HIV, IDUs and stigma, watch an educational video on the importance of health screening (particularly HIV testing), participate in desired screening services and undergo a structured 20-minute ACASI that repeats the attitudes scale. Customers in the control pharmacy will only undergo HIV testing and a structured 20-minute ACASI survey. Semi-structured surveys will be administered to all pharmacy staff to ascertain impact of on-site prevention services on pharmacy personnel and business flow. We will use standard qualitative analytic techniques and GEE to account for clustering in quantitative analyses. The proposed research is highly significant in that it aims to explore a pilot intervention that involves expanding pharmacy services to include HIV testing and to determine if offering HIV testing within a comprehensive prevention approach that includes less stigmatizing screening tests (i.e., blood pressure, glucose and cholesterol screening) increases HIV testing among injection drug users who purchase syringes in pharmacies and their peers (drug-using and/or non-drug using). We will be using new HIV testing technologies and bringing technological innovations and treatment modalities to low-income communities in New York City. If successful, this model can be duplicated not only throughout other high-risk neighborhoods in New York, but in several other cities and states. If our findings are positive, broader public health impact could follow. Pharmacists can partner with clinicians and other health care providers to offer an integrative approach to HIV testing to high-risk injection drug using populations and to other groups with limited access to health care services such as the uninsured and undocumented immigrants. Adoption of this integrative approach to HIV testing on a larger scale could also be implemented and reduce many of the access and stigmatization barriers experienced in marginalized populations for HIV testing while simultaneously increasing and improving general health and well-being by targeting chronic disease outcomes that disproportionately affect marginalized populations.