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 (IDUs) in the United States and international settings, in preparation for a large-scale, multisite, randomized community controlled intervention trial (RCCI-Trial). Pharmacies are the most common health-related facilities throughout the world. IDUs often obtain sterile needles and syringes from pharmacies, and there have been a number of studies showing that use of pharmacies is associated with reduced HIV transmission among IDUs. In a limited number of studies, pharmacies have been mobilized to provide various types of HIV- and health-related services to IDUs. The results of these studies suggest that training pharmacists to provide HIV-related services to IDUs could be a highly effective intervention that could be implemented in a wide variety of cultural settings. An RCCI-Trial is needed to test this intervention. An RCCI-Trial requires careful preparatory study and estimation of feasibility in a number of different locations. The purpose of these linked R21 proposals is to conduct the needed feasibility and preparatory work in five settings across four countries: India, Vietnam, Russia, and the United States (including this application from San Francisco). With the overarching goal of testing feasibility in advance of a coordinated RCCI-Trial in five international settings, the aims for each proposal are as follows:
Aim 1. Assess current pharmacy services and how these services can be expanded to include HIV-related services for IDUs'syringes in pharmacies.
Aim 2. Assess barriers to participation in HIV prevention interventions targeted to IDU syringe customers, including pharmacists'attitudes, IDUs'concerns, and possible interference from law enforcement and policy makers.
Aim 3. Identify potential local sites (i.e., subareas) for a randomized community controlled trial. To accomplish these aims, we have submitted five linked R21 proposals from investigators representing four countries. Each investigator will simultaneously conduct a thorough qualitative and quantitative feasibility investigation adapted from methods used in the National Institute on Drug Abuse's (NIDA's) Rapid Policy Assessment and Response (RPAR) projects. In each site, data collection will include secondary data review;key informant interviews with pharmacists, IDUs, and other stakeholders;and cross-sectional surveys of both IDUs and pharmacists. The overarching goal of this coordinated data collection will be to assess the feasibility of a future multinational RCCI-Trial of a pharmacy-based HIV prevention intervention for IDUs.
This research seeks to provide evidence supporting an expanded role for pharmacists as public health practitioners in the realm of HIV prevention for injection drug users globally, going beyond mere sales to customer engagement aimed at improved well-being. The public's health will benefit from this study in that the outcome will facilitate the development of partnerships between pharmacists, clinicians, and other public health service providers that provide HIV prevention services to injection drug users in resource-poor settings. Findings could lead to increased access to HIV care and treatment, as well as reduced HIV risk and secondary transmission.
