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.
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.