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.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZRG1-AARR-G (53))
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Jenkins, Richard A
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Fenway Community Health Center
United States
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Zaller, Nickolas D; Yokell, Michael A; Apeakorang, Naika et al. (2012) Reported experiences during syringe purchases in Providence, Rhode Island: implications for HIV prevention. J Health Care Poor Underserved 23:1310-26
Zaller, Nickolas D; Yokell, Michael A; Jeronimo, Alexandra et al. (2010) Adverse event associated with a change in nonprescription syringe sale policy. J Am Pharm Assoc (2003) 50:619-22
Zaller, Nickolas; Jeronimo, Alexandra; Bratberg, Jeffrey et al. (2010) Pharmacist and pharmacy staff experiences with non-prescription (NP) sale of syringes and attitudes toward providing HIV prevention services for injection drug users (IDUs) in Providence, RI. J Urban Health 87:942-53