Proposed is a community randomized trial to evaluate the impact of providing enhanced pharmacy services to IDUs accessing syringes from pharmacies through the """"""""Expanded Syringe Access Demonstration Program"""""""" (ESAP), a New York State public health law passed in 2001 that permits non-prescription sales of syringes. Although IDU uptake of the program had been slow among some IDU populations, a multi-level intervention has shown promise for increasing IDU utilization of pharmacies. Preliminary data indicate pharmacist interest in an expanded role, and a majority reported willingness to provide drug treatment and other health-related information to their IDU syringe customers.
The aims of the study are: [1] To evaluate the extent to which enhanced pharmacy services (i.e., provision of health/social service referrals during the syringe purchase), compared to the standard ESAP-pharmacy practice show the following outcomes among IDUs: (a) increased repeat pharmacy use (as a syringe source); (b) increased safe syringe disposal; (c) increased access to HIV and primary care services; (d) increased access to drug treatment (i.e., active planning to enter treatment, drug treatment entry); and (e) increased proportion with health insurance coverage; and [2] To evaluate the extent to which enhanced pharmacy services is more likely to show the following outcomes among pharmacy staff: (a) increased support of ESAP; (b) increased support of enhanced pharmacy services for IDUs; (c) increased new IDU customers and frequency of existing customers; (d) increased prescription customer base. To meet these aims, we will first scale up a multi- component ESAP mobilization in each of our targeted high-risk communities. Concurrently, we will enroll 130 randomly selected pharmacies from a list of ESAP-registered providers to be randomly assigned to the intervention (enhanced pharmacy services + refer IDUs to research site; N=40), AIM-1 control arm (standard syringe sale only + refer IDUs to research site; N=40) or AIM-2 control arm (standard syringe sale only; no IDU referral; N=50). In collaboration with community members and local pharmacists a """"""""Pharmacy Staff Training Manual"""""""" has been developed for training intervention pharmacy staff. Intervention pharmacies will also utilize the innovative drug user-specific Web-based Resource Guide ( to help link IDUs to services (e.g. HIV testing, benefits/entitlement services, etc.). To address Aim 1, pharmacies in the intervention and AIM-1 control arm will refer IDU customers to a local research site for a same/next day appointment where 922 IDUs will undergo a baseline and 3-month follow-up interview to record exposure and outcome measures. To address Aim 2, pharmacy staff from the 40 intervention arm (N=120) and those from an additional 50 pharmacies (N=200) will undergo a baseline (prior to randomization) and two follow-up phone surveys. Outcomes will be analyzed using regression techniques and random effect models to account for correlated pharmacy data. A successful intervention will provide evidence that pharmacies can serve beyond mere syringe sales to more active engagement of IDUs for HIV prevention and referrals into health and social services. ? ? ? ? ?

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Study Section
Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
Program Officer
Denisco, Richard A
Project Start
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New York Academy of Medicine
New York
United States
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DeCuir, Jennifer; Lovasi, Gina S; El-Sayed, Abdulrahman et al. (2018) The association between neighborhood socioeconomic disadvantage and high-risk injection behavior among people who inject drugs. Drug Alcohol Depend 183:184-191
Rudolph, Abby E; Crawford, Natalie D; Latkin, Carl et al. (2017) Multiplex Relationships and HIV: Implications for Network-Based Interventions. AIDS Behav 21:1219-1227
Lewis, Crystal Fuller; Rivera, Alexis V; Crawford, Natalie D et al. (2015) Pharmacy-randomized intervention delivering HIV prevention services during the syringe sale to people who inject drugs in New York City. Drug Alcohol Depend 153:72-7
Crawford, Natalie D; Amesty, Silvia; Rivera, Alexis V et al. (2014) Community Impact of Pharmacy-Randomized Intervention to Improve Access to Syringes and Services for Injection Drug Users. Health Educ Behav 41:397-405
Turner, Alezandria K; Jones, Kandice C; Rudolph, Abby et al. (2014) Physical victimization and high-risk sexual partners among illicit drug-using heterosexual men in New York City. J Urban Health 91:957-68
Crawford, Natalie D; Amesty, Silvia; Rivera, Alexis V et al. (2013) Randomized, community-based pharmacy intervention to expand services beyond sale of sterile syringes to injection drug users in pharmacies in New York City. Am J Public Health 103:1579-82
Turner, A K; Harripersaud, K; Crawford, N D et al. (2013) Differences in HIV risk behavior of injection drug users in New York City by health care setting. AIDS Care 25:1321-9
Amesty, Silvia; Blaney, Shannon; Crawford, Natalie D et al. (2012) Pharmacy staff characteristics associated with support for pharmacy-based HIV testing. J Am Pharm Assoc (2003) 52:472-9, 1-9
Crawford, Natalie D; Blaney, Shannon; Amesty, Silvia et al. (2011) Individual- and neighborhood-level characteristics associated with support of in-pharmacy vaccination among ESAP-registered pharmacies: pharmacists' role in reducing racial/ethnic disparities in influenza vaccinations in New York City. J Urban Health 88:176-85
Amesty, Silvia; Rivera, Alexis V; Fuller, Crystal M (2011) Overview of HIV among injection drug users in New York City: critical next steps to eliminate racial/ethnic disparities. Subst Use Misuse 46:285-94

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