Post exposure prophylaxis among IDU syringe customers-Pharmacy pilot intervention

IDU 注射器顾客的暴露后预防——药房试点干预

基本信息

批准号：
8513957
负责人：
CRYSTAL FULLER LEWIS
金额：
$ 63.31万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-09-01 至 2015-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8513957
关键词：
AIDS prevention AIDS/HIV problem Accounting Acquired Immunodeficiency Syndrome Address Adherence Adverse effects Attitude Behavior Behavioral Caring Centers for Disease Control and Prevention (U.S.)Characteristics Cities Clinical Communities Counseling Data Diagnosis Disease Drug usage Education Educational Materials Effectiveness Enrollment Ethics Event Exposure to Goals HIV HIV Infections HIV Seropositivity HIV risk Health Personnel Health Services Health Services Accessibility Healthcare Hispanics Injecting drug user Injection of therapeutic agent Intervention Interview Knowledge Low income Medical Mind Modeling Needle Sharing Needle-Exchange Programs Needlestick Injuries Neighborhoods New York New York City Newly Diagnosed Occupational Participant Perception Persons Pharmaceutical Services Pharmacists Pharmacy facility Phase Prevalence Prevention approach Prevention strategy Printing Probability Prophylactic treatment Protocols documentation Public Health Randomized Controlled Trials Recommendation Regimen Reporting Research Research Personnel Risk Risk Behaviors Risk Reduction Sales Services Shares syringes Site Social Network Source Sterility Structure Subgroup Surveys Syringes Target Populations Techniques Testing Time Toxic effect United States Dept. of Health and Human Services Unsafe Sex Visit antiretroviral therapy base case-by-case basis community burden demographics design eligible participant experience follow-up high risk high risk behavior informant innovation men who have sex with men peer prevent prevention service programs public health relevance sex sex risk standard of care success transmission process

项目摘要

DESCRIPTION (provided by applicant): The purpose of this research is to evaluate a structural pilot intervention which aims to expand pharmacy services to include provision of non-occupational HIV post exposure prophylaxis (nPEP) and risk reduction information to injection drug users (IDUs) who buy syringes at two pharmacies registered with the New York State Expanded Syringe Access Program (ESAP), a program allowing pharmacies to sell syringes without a prescription to help reduce the spread of HIV among IDUs. PEP is the standard of care for health care workers who experience an accidental needle stick. The probability of HIV transmission in IDUs through sharing syringes is either similar to or higher than the risk of an occupational needle stick, which supports the use of nPEP in these cases. There is a preponderance of data supporting PEP (i.e., antiretroviral therapy) as an effective strategy to prevent HIV infection. Thus, PEP is recommended by the U.S. Department of Health and Human Services in non-occupational cases (exposure via high risk sex or injection behavior) when the exposure source is HIV positive or when the source is unknown but from a HIV prevalent community (e15%). ESAP's success creates a new window of opportunity to offer nPEP as a medically-based HIV prevention approach to low-risk IDUs such as ESAP participants who mostly access sterile syringes but may have an unplanned exposure. By targeting pharmacies in low-income, black and Hispanic communities where HIV burden is highest, a pharmacy-based nPEP program has the potential to create a more comprehensive HIV prevention plan that addresses the long-standing problem of racial disparities in HIV/AIDS. Thus, we aim to qualitatively and quantitatively evaluate a pharmacy-based nPEP program by comparing IDU syringe customers who would agree to pharmacy-based nPEP vs. those who would decline (in the event of an accidental exposure) with respect to demographics, risk behaviors, perceptions of health care access/needs among IDU syringe customers. Using a pre/post design targeted to syringe customers and their peers we will determine if IDUs/peers who receive nPEP information and risk reduction counseling are more likely to 1) have increased and accurate knowledge of nPEP as an HIV prevention strategy (over time), and 2) more frequently share accurate information about nPEP, risk reduction, and HIV prevention with peers (over time) with respect to baseline demographics, risk behavior, and healthcare needs and access (Aim 2). Among those request nPEP and eligible (i.e., low injection/sex risk IDUs) we will assess side effects and nPEP adherence, risk behavior, social networks, and attitudes and opinions about nPEP via clinical follow up. We will conduct key- informant interviews among key stakeholders (n=15) and enroll IDU syringe customers (and referred peers) from pharmacies providing nPEP information/risk reduction counseling via print materials and video followed by a baseline A-CASI survey (n=638). A peer-driven intervention component will facilitate recruitment and dissemination of nPEP information. Participants will return in 3-months to assess behavior, knowledge, and spread of nPEP information. Analysis will include standard qualitative and quantitative regression techniques.

描述（由申请人提供）：本研究的目的是评估结构性试点干预措施，该干预旨在扩大药房服务，包括提供非职业HIV暴露后预防后预防（NPEP）（NPEP），并向注射吸毒者（IDUS）降低风险信息（IDUS）他们在纽约州扩展注射器访问计划（ESAP）注册的两家药房购买注射器，该计划允许药房在没有处方的情况下出售注射器，以帮助减少艾滋病毒在IDUS中的传播。 PEP是经历意外针刺的医疗保健工作者的护理标准。通过共享注射器在IDU中传播HIV的可能性类似于或高于职业针杆的风险，在这些情况下，它支持NPEP的使用。支持PEP（即抗逆转录病毒疗法）作为预防HIV感染的有效策略。因此，当美国卫生和公共服务部在非职业案件（通过高风险性行为或注射行为暴露）中，推荐PEP当暴露源为HIV阳性或未知源时，但来自HIV普遍存在的社区（E15）％）。 ESAP的成功创造了一个新的机会窗口，将NPEP作为一种基于医学的HIV预防方法，用于低风险IDU，例如ESAP参与者，他们主要访问无菌注射器，但可能会有计划外的暴露。通过针对艾滋病毒负担最高的低收入，黑人和西班牙裔社区的药房，基于药房的NPEP计划有可能制定更全面的艾滋病毒预防计划，以解决艾滋病毒/艾滋病中种族歧视的长期存在问题。因此，我们的目标是通过比较同意基于药房的NPEP与那些在人口统计学方面的拒绝（如果发生意外暴露）的人，对基于药房的NPEP与那些会拒绝的人（如果是偶然暴露）的人来定性和定量评估基于药房的NPEP计划。，IDU注射器客户对医疗保健访问/需求的看法。使用针对注射器客户及其同龄人的预/邮政设计，我们将确定是否会收到NPEP信息和降低风险咨询的IDU/同行更有可能增加，而是对NPEP作为HIV预防策略的提高和准确的了解（随着时间的推移），以及2）关于基线人口统计，风险行为以及医疗保健需求和访问，更频繁地与同行（随着时间的时间）更频繁地与同行（随着时间的时间）共享有关NPEP，降低风险和艾滋病毒的准确信息（AIM 2）。在那些要求NPEP和合格的人中（即低注射/性风险IDU），我们将通过临床随访评估副作用和NPEP依从性，风险行为，社交网络，社交网络以及对NPEP的态度和观点。我们将对主要利益相关者（n = 15）进行关键线人访谈，并从药房中注册IDU注射器客户（和引用的同行），通过印刷材料和视频提供NPEP信息/降低风险咨询，然后进行基线A-CASI调查（n = n = 638）。同行驱动的干预部分将有助于招募和传播NPEP信息。参与者将返回3个月以评估NPEP信息的行为，知识和传播。分析将包括标准定性和定量回归技术。