International Feasibility Study of Pharmacy-based HIV Prevention: San Francisco

描述(申请人提供)：这项研究的目的是评估利用药房作为公共卫生场所向美国和国际环境中的注射吸毒者(IDU)提供艾滋病毒相关服务的可行性，为大规模、多地点、随机社区控制干预试验(RCCI-Trial)做准备。药房是全世界最常见的与健康相关的设施。注射吸毒者通常从药房获得无菌针头和注射器，一些研究表明，使用药房与减少注射吸毒者之间的艾滋病毒传播有关。在有限数量的研究中，已经动员药房向注射吸毒者提供各种类型的艾滋病毒和与健康有关的服务。这些研究的结果表明，培训药剂师向注射吸毒者提供艾滋病毒相关服务可能是一种非常有效的干预措施，可以在各种文化环境中实施。需要一项RCCI试验来测试这种干预。RCCI试验需要在多个不同地点进行仔细的准备研究和可行性评估。这些关联的R21提案的目的是在印度、越南、俄罗斯和美国(包括旧金山的这份申请)的四个国家/地区的五个环境中进行必要的可行性和准备工作。总体目标是在五个国际环境中进行协调的RCCI试验之前测试可行性，每项提议的目的如下：目标1.评估目前的药房服务，以及如何扩大这些服务，使其包括药房中与艾滋病毒有关的注射吸毒者注射器服务。目的2.评估参与针对注射吸毒者的艾滋病毒预防干预的障碍，包括药剂师的态度、注射吸毒者的关切以及执法部门和政策制定者可能的干预。目的3.为随机社区对照试验确定潜在的局部地点(即分区)。为了实现这些目标，我们提交了来自代表四个国家的调查人员的五份相关的R21提案。每个调查员将同时进行彻底的定性和定量可行性调查，采用国家药物滥用研究所(NIDA)快速政策评估和反应(RPAR)项目中使用的方法。在每个站点，数据收集将包括二次数据审查；与药剂师、注射吸毒者和其他利益相关者的关键线人访谈；以及对注射吸毒者和药剂师的横断面调查。这种协调数据收集的首要目标将是评估未来跨国RCCI试验的可行性--针对注射吸毒者的基于药房的艾滋病毒预防干预试验。公共卫生相关性：这项研究寻求提供证据，支持药剂师作为公共卫生从业人员在全球注射吸毒者艾滋病毒预防领域发挥更大作用，超越单纯的销售，以改善福祉为目的的客户参与。公众的健康将从这项研究中受益，因为这项研究的结果将促进药剂师、临床医生和其他公共卫生服务提供者之间发展伙伴关系，这些公共卫生服务提供者向资源匮乏的注射吸毒者提供艾滋病毒预防服务。这些发现可能导致更多人获得艾滋病毒护理和治疗，并降低艾滋病毒风险和二次传播。

DESCRIPTION (provided by applicant): 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 (IDUs) in the United States and international settings, in preparation for a large-scale, multisite, randomized community controlled intervention trial (RCCI-Trial). Pharmacies are the most common health-related facilities throughout the world. IDUs often obtain sterile needles and syringes from pharmacies, and there have been a number of studies showing that use of pharmacies is associated with reduced HIV transmission among IDUs. In a limited number of studies, pharmacies have been mobilized to provide various types of HIV- and health-related services to IDUs. The results of these studies suggest that training pharmacists to provide HIV-related services to IDUs could be a highly effective intervention that could be implemented in a wide variety of cultural settings. An RCCI-Trial is needed to test this intervention. An RCCI-Trial requires careful preparatory study and estimation of feasibility in a number of different locations. The purpose of these linked R21 proposals is to conduct the needed feasibility and preparatory work in five settings across four countries: India, Vietnam, Russia, and the United States (including this application from San Francisco). With the overarching goal of testing feasibility in advance of a coordinated RCCI-Trial in five international settings, the aims for each proposal are as follows: Aim 1. Assess current pharmacy services and how these services can be expanded to include HIV-related services for IDUs' syringes in pharmacies. Aim 2. Assess barriers to participation in HIV prevention interventions targeted to IDU syringe customers, including pharmacists' attitudes, IDUs' concerns, and possible interference from law enforcement and policy makers. Aim 3. Identify potential local sites (i.e., subareas) for a randomized community controlled trial. To accomplish these aims, we have submitted five linked R21 proposals from investigators representing four countries. Each investigator will simultaneously conduct a thorough qualitative and quantitative feasibility investigation adapted from methods used in the National Institute on Drug Abuse's (NIDA's) Rapid Policy Assessment and Response (RPAR) projects. In each site, data collection will include secondary data review; key informant interviews with pharmacists, IDUs, and other stakeholders; and cross-sectional surveys of both IDUs and pharmacists. The overarching goal of this coordinated data collection will be to assess the feasibility of a future multinational RCCI-Trial of a pharmacy-based HIV prevention intervention for IDUs. PUBLIC HEALTH RELEVANCE: This research seeks to provide evidence supporting an expanded role for pharmacists as public health practitioners in the realm of HIV prevention for injection drug users globally, going beyond mere sales to customer engagement aimed at improved well-being. The public's health will benefit from this study in that the outcome will facilitate the development of partnerships between pharmacists, clinicians, and other public health service providers that provide HIV prevention services to injection drug users in resource-poor settings. Findings could lead to increased access to HIV care and treatment, as well as reduced HIV risk and secondary transmission.