COMMUNITY CONTEXT, SEP OPERATIONS, & HIV RISK AMONG IDUs

描述(由申请人提供)：建议对注射吸毒者(IDU)中注射器交换计划(SEP)的操作特征和个体艾滋病毒危险行为的变化进行纵向跨地点比较研究。总体目标是确定SEP操作特征的差异如何影响SEP客户中HIV风险行为的变化。最近对SEP研究的回顾表明，对SEP操作特征的忽视对计划有效性有偏见的解释。然而，很少有SEP研究提供程序信息，如注射器分配方案和辅助服务的可用性。缺乏细节尤其有问题，因为SEP必须制定与注射器分配协议、对注射器的限制以及补充辅助服务的可用性相关的政策，而没有关于这些选择影响的经验数据。为了解决这个问题，我们提出了以下具体目标：(1)比较使用不同注射器分配方案的SEP的注射吸毒者中艾滋病毒危险行为的变化；(2)比较使用SEP的注射吸毒者与使用没有这种限制的SEP的注射吸毒者之间艾滋病毒危险行为的变化；以及(3)比较使用提供补充辅助医疗服务的SEP的注射吸毒者与使用不提供此类辅助服务的SEP的注射吸毒者之间艾滋病毒危险行为和对医疗、社会和物质使用服务利用的变化。为了实现这些目标，我们将比较SEP客户在SEP的风险行为和以下操作特征：1a)一对一交换和一对一交换以及额外的注射器；lb)一对一交换和基于需要的分配，lc)一对一加上额外的注射器和基于需要的分配；2)每次就诊时交换的注射器数量与不限制交换的注射器；以及3)在SEP站点提供补充辅助服务(例如，HIV筛查和医疗提供者，包括护士和/或医生助理)和没有辅助服务。选择的5个SEP中的每一个都在感兴趣的三个操作变量中的两个上与另一个程序匹配，从而允许对第三个变量进行比较。将从这些SEP及其覆盖地区招募1500名IDU(750名SEP客户；750名使用IDU的非SEP)，进行为期6个月的三波数据收集，从01年开始，到05年结束。

DESCRIPTION (provided by applicant): Proposed is a longitudinal cross-site comparison study of syringe exchange program (SEP) operational characteristics and changes in individual HIV risk behaviors among injection drug users (IDUs). The overall aim is to determine how differences in SEP operational characteristics may impact changes in HIV risk behavior among SEP clients. Recent reviews of SEP studies suggest that inattention to SEP operational characteristics have biased interpretations of program effectiveness. Yet, few SEP studies provide program information such as syringe distribution protocols and availability of ancillary services. This lack of detail is particularly problematic since SEPs must set policies related to syringe distribution protocol, limits on syringes, and availability of complementary ancillary services without benefit of empirical data on the impact of these choices. To address this problem we propose the following specific aims: (1) To compare changes in HIV risk behaviors among IDUs who use SEPs with different syringe distribution protocols, (2) To compare changes in HIV risk behaviors among IDUs who use a SEP with a limit on the number of syringes that can be exchanged with IDUs who use an SEP with no such limit, and (3), To compare changes in HIV risk behaviors and utilization of medical, social, and substance use services among IDUs who use an SEP that provides complementary ancillary medical services as compared to IDUs who use a SEP without such ancillary services. To accomplish these aims, we will compare SEP client risk behaviors at SEPs with the following operational characteristics: la) one-for-one exchange versus one-for-one plus extra syringes; lb) one-for-one exchange versus need-based distribution, lc) one-for-one plus extra syringes versus need-based distribution; 2) limits on number of syringes exchanged per visit versus no limits on syringes exchanged; and 3) availability of complementary ancillary services (e.g. HIV screening and medical provider, including nurses and/or physician assistant) at SEP sites versus no ancillary services. Each of the 5 selected SEPs is matched to another program on two of the three operational variables of interest, thus permitting comparisons on the third variable. 1,500 IDUs (750 SEP clients; 750 non-SEP using IDUs) will be recruited, interviewed, and followed for 6 months in three waves of data collection beginning in Year 01 and ending in Year 05 from these SEPs and their catchment areas.