Pharmacy Referral Intervention: IDU Access to Services

建议进行一项社区随机试验，以评估提供增强的药房服务对以下人群的影响： 注射吸毒者通过“扩大注射器获取示范方案”从药房获取注射器 （ESAP），纽约州2001年通过的公共卫生法，允许非处方销售注射器。 虽然在一些注射吸毒者群体中，注射吸毒者对该方案的接受速度缓慢，但多层次的干预措施已 显示出增加注射吸毒者利用药店的前景。初步数据表明，药剂师对 扩大了作用，大多数国家报告愿意提供戒毒治疗和其他与健康有关的信息 给他们的注射器客户该研究的目的是：[1]评估增强药学的程度 服务（即，在购买注射器期间提供保健/社会服务转介），与标准 ESAP-药房实践表明，注射吸毒者中有以下结果：（a）重复使用药房的情况增加（作为一种药物）， （a）减少注射器来源）;（B）增加安全处置注射器;（c）增加获得艾滋病毒和初级保健服务的机会;（d） 增加获得药物治疗的机会（即，积极计划进入治疗，药物治疗进入）;及（e） 增加健康保险覆盖的比例;[2]评估增强药房的程度 服务更可能在药房工作人员中显示以下结果：（a）增加对ESAP的支持;（B） （c）增加新的注射吸毒者顾客和增加 现有客户;（d）增加处方客户基础。为了实现这些目标，我们将首先扩大一个多- 在我们的每一个目标高风险社区进行ESAP动员。同时，我们将招募130名 从ESAP注册供应商名单中随机选择的药房，随机分配给 干预（加强药房服务+将注射吸毒者转诊至研究中心; N=40），AIM-1对照组（标准 仅销售注射器+将IDU转诊至研究中心; N=40）或AIM-2对照组（仅销售标准注射器;无IDU 转诊; N=50）。与社区成员和当地药剂师合作， 为培训干预药房工作人员制定了“手册”。干预药房还将利用 创新药物使用者专用网上资源指南（www.harlemresourceguide.com），以帮助将注射吸毒者与 服务（如艾滋病毒检测、福利/应享权利服务等）。为了实现目标1，干预措施中的药店 和AIM-1控制臂将介绍注射吸毒者到当地研究中心进行同一天/次日预约， 922名注射吸毒者将接受基线和3个月随访访谈，以记录暴露和结局指标。到 解决目标2，来自40个干预组（N=120）和另外50个药房的药房工作人员 （N=200）将接受基线（随机化前）和两次随访电话调查。成果将 使用回归技术和随机效应模型进行分析，以解释相关的药房数据。一 成功的干预将提供证据表明，药店可以提供超越单纯的注射器销售，以更积极的 * 让注射吸毒者参与艾滋病毒预防工作，并将其转介到保健和社会服务机构。

Proposed is a community randomized trial to evaluate the impact of providing enhanced pharmacy services to IDUs accessing syringes from pharmacies through the "Expanded Syringe Access Demonstration Program" (ESAP), a New York State public health law passed in 2001 that permits non-prescription sales of syringes. Although IDU uptake of the program had been slow among some IDU populations, a multi-level intervention has shown promise for increasing IDU utilization of pharmacies. Preliminary data indicate pharmacist interest in an expanded role, and a majority reported willingness to provide drug treatment and other health-related information to their IDU syringe customers. The aims of the study are: [1] To evaluate the extent to which enhanced pharmacy services (i.e., provision of health/social service referrals during the syringe purchase), compared to the standard ESAP-pharmacy practice show the following outcomes among IDUs: (a) increased repeat pharmacy use (as a syringe source); (b) increased safe syringe disposal; (c) increased access to HIV and primary care services; (d) increased access to drug treatment (i.e., active planning to enter treatment, drug treatment entry); and (e) increased proportion with health insurance coverage; and [2] To evaluate the extent to which enhanced pharmacy services is more likely to show the following outcomes among pharmacy staff: (a) increased support of ESAP; (b) increased support of enhanced pharmacy services for IDUs; (c) increased new IDU customers and frequency of existing customers; (d) increased prescription customer base. To meet these aims, we will first scale up a multi- component ESAP mobilization in each of our targeted high-risk communities. Concurrently, we will enroll 130 randomly selected pharmacies from a list of ESAP-registered providers to be randomly assigned to the intervention (enhanced pharmacy services + refer IDUs to research site; N=40), AIM-1 control arm (standard syringe sale only + refer IDUs to research site; N=40) or AIM-2 control arm (standard syringe sale only; no IDU referral; N=50). In collaboration with community members and local pharmacists a "Pharmacy Staff Training Manual" has been developed for training intervention pharmacy staff. Intervention pharmacies will also utilize the innovative drug user-specific Web-based Resource Guide (www.harlemresourceguide.com) to help link IDUs to services (e.g. HIV testing, benefits/entitlement services, etc.). To address Aim 1, pharmacies in the intervention and AIM-1 control arm will refer IDU customers to a local research site for a same/next day appointment where 922 IDUs will undergo a baseline and 3-month follow-up interview to record exposure and outcome measures. To address Aim 2, pharmacy staff from the 40 intervention arm (N=120) and those from an additional 50 pharmacies (N=200) will undergo a baseline (prior to randomization) and two follow-up phone surveys. Outcomes will be analyzed using regression techniques and random effect models to account for correlated pharmacy data. A successful intervention will provide evidence that pharmacies can serve beyond mere syringe sales to more active engagement of IDUs for HIV prevention and referrals into health and social services.