This resubmission of R21 DA024971 is a feasibility study of pharmacy-based HIV Interventions among injection drug users (IDUs) in Chennai, India. Transmission of HIV and other bloodborne viruses has been linked to restricting syringe access through pharmacies. Expanding syringe access through pharmacies has reduced injection-related HIV risk. One potential strategy is to work with pharmacists to serve as agents of public health, encouraging them to provide syringes and expanded services to their IDUs customers. To date, no comprehensive studies have been conducted to understand what elements of pharmacist training and services are most critical in reducing the disease risks. A multi-site intervention trial to fill this gap could have a significant impact in locations injection-related HIV transmission is high. This application is one of five linked R21 applications - US (2), India (1), Russia (1), and Vietnam (1) - that will explore the possibility of participating in such a trial. Each site has information about the local injection-related HIV epidemic and IDU use of pharmacies to obtain syringes. More information is needed to understand the local culture of pharmacies/pharmacists, willingness to participate, and local barriers to an intervention. Additionally, determining the receptiveness of IDUs to participate in such a trial are also needed. This application from Johns Hopkins Bloomberg School of Public Health proposes a two-year scope of work in Chennai that uses Rapid Policy Assessment and Response methods to learn from pharmacists, IDUs, and local public health and law enforcement officials to develop an intervention. Also, data will be collected from a sample of 400 IDUs and 50 pharmacists. This 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 participation in a HIV prevention and access to care intervention targeted to IDU customers;and (3) to identify potential local pharmacy and geographic sites for a randomized community controlled trial. Based on the study design this application can stand alone or be combined with data from the other applications to develop a culturally appropriate intervention trial in India.
This proposal has high public health relevance due to the high level of HIV among IDUs in India and many other countries including the US.
