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.

说明（由申请人提供）：本研究的目的是评估一项结构性试点干预措施，该干预措施旨在扩大药房服务，包括向注射吸毒者 (IDU) 提供非职业性 HIV 暴露后预防 (nPEP) 和降低风险信息他们在纽约州扩大注射器使用计划 (ESAP) 注册的两家药店购买注射器，该计划允许药店在没有处方的情况下销售注射器，以帮助减少艾滋病毒在注射吸毒者中的传播。 PEP 是针对意外针刺伤医护人员的护理标准。注射吸毒者通过共用注射器传播艾滋病毒的可能性与职业针刺的风险相似或更高，这支持在这些情况下使用 nPEP。有大量数据支持 PEP（即抗逆转录病毒治疗）作为预防 HIV 感染的有效策略。因此，美国卫生与公众服务部建议在非职业病例（通过高风险性行为或注射行为暴露）中，当暴露源为 HIV 阳性或暴露源未知但来自 HIV 流行社区时，进行 PEP（e15 %）。 ESAP 的成功创造了一个新的机会之窗，为低风险 IDU 提供 nPEP 作为一种基于医学的 HIV 预防方法，例如 ESAP 参与者，他们大多使用无菌注射器，但可能会意外暴露。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，解决艾滋病毒/艾滋病方面长期存在的种族差异问题。因此，我们的目标是通过比较同意基于药房的 nPEP 的 IDU 注射器客户与那些拒绝（在意外暴露的情况下）的 IDU 注射器客户的人口统计、风险行为，定性和定量地评估基于药房的 nPEP 计划、注射吸毒者注射器客户对医疗保健获取/需求的看法。通过针对注射器使用者及其同伴的前/后设计，我们将确定接受 nPEP 信息和风险降低咨询的注射吸毒者/同伴是否更有可能 1) 增加和准确地了解 nPEP 作为艾滋病毒预防策略（随着时间的推移），以及 2) 更频繁地与同行（随着时间的推移）分享关于基线人口统计、风险行为以及医疗保健需求和获取方面的 nPEP、风险降低和 HIV 预防的准确信息（目标 2）。在那些请求 nPEP 和符合资格的人（即低注射/性风险 IDU）中，我们将通过临床随访评估副作用和 nPEP 依从性、风险行为、社交网络以及对 nPEP 的态度和意见。我们将在关键利益相关者 (n=15) 中进行关键信息访谈，并从药房招募 IDU 注射器客户（以及推荐的同行），通过印刷材料和视频提供 nPEP 信息/风险降低咨询，然后进行基线 A-CASI 调查 (n= 638）。同行驱动的干预措施将促进 nPEP 信息的招募和传播。参与者将在 3 个月后返回，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。