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
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Columbia University (N.Y.)
Public Health & Prev Medicine
Schools of Public Health
New York
United States
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