Feasibility of Pharmacy-Based HIV Interventions among IDUs: 2 New England Cities

描述（由申请人提供）：艾滋病毒和其他血源性病毒在注射吸毒者（IDUs）之间的传播与通过药店限制注射器获取有关。相反，通过药店扩大注射器获取的战略已被证明可以减少与注射有关的艾滋病毒风险。最好与药剂师合作，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，而且扩大对光顾其药房的注射吸毒者的服务。没有进行全面的研究来了解药剂师培训的哪些内容以及哪些服务在减少疾病传播风险方面最关键。理想情况下，多地点干预试验可以填补这一空白，在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。在开始这种试验之前，需要确定适当的地点。这个申请是五个相关R21申请中的一个——两个在美国，一个来自印度、俄罗斯和越南——已经开始探索参与这种试验的可能性。每个站点都有关于当地与注射有关的艾滋病毒流行情况以及注射吸毒者已经在多大程度上使用药房获得注射器的信息。需要更多的信息来评估药剂师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IDU注射器客户对参与这种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。这项申请是针对一项新英格兰研究，使用马萨诸塞州波士顿和美国罗德岛普罗维登斯两个城市，并提出一个为期两年的工作范围，采用快速政策评估和反应（RPAR）项目的定性方法，向药剂师、他们所服务的注射吸毒者、当地公共卫生和执法官员学习，并评估潜在干预措施的可行性。将从注射吸毒者和药剂师的样本中收集调查数据，以更好地确定干预试验中要解决的结果措施。这项可行性研究有三个主要目的：(1)评估目前的药房服务，以及如何将这些服务扩大到包括在药房购买注射器的注射吸毒者的艾滋病毒相关服务；(2)评估IDU和药房工作人员参与针对IDU注射器客户的艾滋病毒预防和护理干预的障碍，包括药剂师的态度，以及执法和政策制定者可能的干预；(3)确定各城市潜在的社区选址，进行随机社区对照试验。除了确定每个城市中适合纳入随机试验的社区外，我们还将通过获取评估城市可比性所需的信息，评估将城市（而不是每个城市中的社区）纳入随机试验的可行性。该应用程序可以单独使用，也可以与其他相关应用程序的数据相结合，以评估在美国新英格兰测试和开发适当和可接受的基于药房的干预措施的可行性。公共卫生相关性：本研究的目的是评估在美国和国际环境中使用药房作为公共卫生场所向注射吸毒者提供艾滋病毒相关服务的可行性，为一项大规模、多地点随机对照干预试验做准备。这是五个相关R21提案之一。每项研究将评估使用其站点进行未来试验的可行性，所有站点将向协调中心提供数据，以便进行跨站点评估。该提案的总体公共卫生目标是通过仔细开发和测试基于药物的干预措施来减少与注射相关的艾滋病毒和丙型肝炎病毒传播和风险行为。

DESCRIPTION (provided by applicant): Transmission of HIV and other blood borne viruses among injection drug users (IDUs) has been linked to restricting syringe access through pharmacies. Conversely, strategies that have expanded syringe access through pharmacies have been shown to reduce injection-related HIV risk. The best work with pharmacists to increase their willingness to serve as agents of public health, encouraging them to provide not just more syringes but expanded services to the IDUs who patronize their pharmacies. 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. Ideally, 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, appropriate sites need to be identified. This application is one of five linked R21 applications - two in the U. S. and one each from India, Russia, and Vietnam -- that have begun to explore the possibility of participating in such a trial. Each site has information about the local injection-related HIV epidemic and the extent to which IDUs already use pharmacies to obtain syringes. More information is needed to assess pharmacists' 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 is for a New England study, using two cities, Boston, MA and Providence, RI, USA and proposes a two-year scope of work that adopts the qualitative methodology of Rapid Policy Assessment and Response (RPAR) projects to learn from pharmacists, the IDUs they serve, local public health and law enforcement officials and assess feasibility of potential interventions. Survey data will be collected from a sample of IDUs and pharmacists to better determine the outcome measures to be addressed in the intervention trial. This feasibility 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 syringes in pharmacies; (2) to assess barriers to IDU and pharmacy staff participation in HIV prevention and access to care intervention targeted to IDU syringe customers, including pharmacists' attitudes, and possible interference from law enforcement and policy makers; and (3) to identify potential local neighborhood sites in each city for a randomized community controlled trial. In addition to identifying appropriate neighborhoods within each city for inclusion in the randomized trial, we will additionally evaluate the feasibility of including the cities (rather than neighborhoods within each city) in the randomized trial, by obtaining information needed to assess the comparability of the cities. This application can stand alone or be combined with data from the other linked applications to assess the feasibility of testing and developing appropriate and acceptable pharmacy based interventions in New England, USA. PUBLIC HEALTH RELEVANCE: The purpose of this study is to assess the feasibility of using pharmacies as public health venues to provide HIV-related services to injection drug users in U.S. and international settings in preparation for a large-scale, multi-site randomized controlled intervention trial. This is one of five linked R21 proposals. Each study will assess the feasibility of using their site for a future trial and all sites will contribute data to a Coordinating Center for a cross-site assessment. The overarching public health goal of this proposal is to reduce injection related HIV and HCV transmission and risk behaviors through careful development and testing of a pharmacy-based intervention.