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:  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  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 (www.harlemresourceguide.com) 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.
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