Feasibility of Pharmacy-Based HIV Interventions among IDUs: Ha Giang, Vietnam

描述(由申请人提供)：艾滋病毒和其他血液传播病毒在注射吸毒者(IDU)中的传播与限制使用注射器有关。相反，通过药房扩大获得注射器的战略已被证明可以降低与注射有关的艾滋病毒风险。其中最好的是与药剂师合作，提高他们作为公共卫生代理人的意愿，鼓励他们不仅提供更多的注射器，而且向光顾其药店的注射吸毒者提供与艾滋病毒和药物滥用有关的服务。但到目前为止，还没有进行全面的研究，以了解药剂师培训的哪些要素以及哪些服务在降低疾病传播风险方面最关键。为填补这一空白而进行的多点干预试验可能会对注射相关艾滋病毒传播造成重大负担的地区产生重大影响。然而，在开始这样的试验之前，需要确定合适的地点。这项申请是五个相互关联的R21申请之一--两个来自美国，一个来自印度、俄罗斯和越南--用于可能的研究地点，以探索基于药房的干预试验的可行性。每个网站都有关于当地与注射有关的艾滋病毒流行以及注射吸毒者已经在多大程度上利用药房获得注射器的信息。在这一点上，需要更多的信息来了解当地药房和药剂师的文化，他们参与此类试验的意愿，以及制定和实施干预措施的当地障碍。此外，还需要确定注射吸毒器消费者对参与此类试验的接受程度以及社会和政治背景的影响，以帮助确定多地点试验的可行性。Abt Associates Inc.针对越南河江镇提出的这份申请，提出了一个为期两年的工作范围，采用快速政策评估和反应(RPAR)项目的方法，以定性访谈和定量调查为基础，从药剂师、他们所服务的注射吸毒者、当地公共卫生和执法官员那里了解足够多的信息，以开发可以在美国和国际地点的各种当地背景下测试的干预措施。将对所有关键的举报群体进行定性访谈，并对注射吸毒者和药房经理进行抽样调查，以更好地确定干预试验中将使用的干预措施和结果衡量标准。这项探索性研究有三个主要目标：(1)评估目前的药房服务，以及如何将这些服务扩展到包括在药房购买或以其他方式获得注射器的注射吸毒者的艾滋病毒相关服务；(2)评估注射吸毒者和药房工作人员参与针对注射吸毒者的艾滋病毒预防和治疗干预的障碍，包括药剂师的态度，以及执法部门、政治领导人和政策制定者可能的干预；以及(3)确定潜在的当地随机社区对照试验地点。在不同的国内和国际地点进行可行性研究具有重要的方法和背景优势。公共卫生相关性：该项目与公共卫生高度相关，因为它将有助于为注射吸毒者开发创新、可复制和可持续的艾滋病毒预防和护理干预措施。在许多发展中国家和转型国家，艾滋病毒流行日益严重，集中在注射吸毒者中，但几乎没有扩大干预措施来接触到这一重要人群。将通过该项目制定的干预措施将利用药房，这是世界上卫生服务最普遍的场所。

DESCRIPTION (provided by applicant): Transmission of HIV and other blood borne viruses among injection drug users (IDUs) has been linked to restrictions on syringe access. Conversely, strategies that have expanded syringe access through pharmacies have been shown to reduce injection-related HIV risk. The best of these work with pharmacists to increase their willingness to serve as agents of public health, encouraging them to provide not just more syringes but expanded HIV- and substance abuse-related services to the IDUs who patronize their pharmacies. But to date no comprehensive studies have been undertaken to understand what elements of pharmacist training and which services are most critical in reducing the risks for disease transmission. A multi-site intervention trial to fill this gap could have a significant impact in locations in which injection-related HIV transmission poses significant burdens. Before such a trial can begin, however, appropriate sites need to be identified. This application is one of five linked R21 applications- two from the U. S. and one each from India, Russia, and Vietnam - for possible study sites to explore the feasibility of a trial of pharmacy-based interventions. Each site has information about the local injection-related HIV epidemic and the extent to which IDUs already use pharmacies to obtain syringes. At this point, more information is needed to understand the local culture of pharmacies and pharmacists, their willingness to participate in such a trial, and the local barriers to developing and implementing an intervention. Additionally, determining the receptiveness of IDU syringe customers to participating in such a trial and the influences of the social and political contexts are also needed to help determine feasibility of a multi-site trial. This application from Abt Associates Inc. for Ha Giang town, Vietnam proposes to a two-year scope of work that adopts the methodology of Rapid Policy Assessment and Response (RPAR) projects to learn, based on qualitative interviews and quantitative surveys, from pharmacists, the IDUs they serve, local public health and law enforcement officials enough to develop an intervention that can be tested in a variety of local contexts in U.S. and international sites. Qualitative interviews will be conducted with all key informant groups and quantitative surveys will be done with a sample of IDUs and a census of pharmacy mangers to better determine the interventions and outcome measures to be used in the intervention trial. This exploratory study has three major aims: (1) to assess current pharmacy services and how these services can be expanded to include HIV related services for IDUs who purchase or otherwise access syringes in pharmacies; (2) to assess barriers to IDU and pharmacy staff participation in HIV prevention and treatment interventions targeted to IDU customers, including pharmacists' attitudes, and possible interference from law enforcement, political leaders, and policy makers; and (3) to identify potential local sites for a randomized community controlled trial. There are important methodological and contextual advantages of conducting feasibility studies in a diverse set of domestic and international sites. PUBLIC HEALTH RELEVANCE: This project is highly relevant to public health in that it will help to develop innovative, replicable, and sustainable HIV prevention and care interventions for injection drug users. In many developing and transitional countries there are growing HIV epidemics that are concentrated among IDUs but there are few scaled-up interventions to reach this important population. The interventions to be developed through project will utilize pharmacies, which are the most widespread settings for health services in the world.