The purpose of this community-based evaluation study is to pilot test the feasibility of expanding pharmacy services to include provision of HIV testing referrals and services to injection drug users (IDUs) who purchase syringes in pharmacies in the Harlem community of New York City. In 2001, New York State pharmacies were allowed to register to sell syringes without a prescription through the Expanded Syringe Access Demonstration Program (ESAP), a public health policy targeted to IDUs to reduce syringe sharing and subsequent HIV transmission. This proposed evaluation study is based on two observations: black and Hispanic IDUs are disproportionately affected by HIV, and some pharmacists support ESAP and consider their work to include public health practice. Given our research team's extensive research in evaluating pharmacy syringe access, we believe that extending services, such as HIV testing, is a logical next step in the effort to help reduce racial disparities in HIV. Thus, the specific aims are: (1) to pilot test the feasibility of 10 ESAP-registered pharmacies in the delivery of HIV testing referrals to local HIV testing sites among IDU-syringe customers;and (2) to evaluate the feasibility of offering and performing HIV counseling and testing to IDU syringe-purchasing customers in 2 additional pilot pharmacies. To accomplish these aims, 10 pharmacies from the Harlem community will be randomly selected from 100 ESAP-registered pharmacies in the Harlem area. In collaboration with community members and local pharmacists, the research team will utilize a previously developed training module for pharmacists and pharmacy staff on the availability of HIV testing services, and how to engage/offer referrals to IDU syringe customers. IDUs who receive services from the pilot pharmacies will be asked to participate in a brief structured survey administered at the pharmacy by research staff. Among approximately 362 IDUs, we will compare those who have used the HIV testing referral vs. those who did not with respect to demographics, drug and sexual risk behaviors, perceptions and attitudes toward HIV testing, prior HIV testing, and previous HIV-positive diagnosis (Aim 1). We will also select and train pharmacy staff at 2 additional pilot pharmacies to perform HIV counseling and testing on-site (Aim 2);among IDUs who are offered on-site testing (N=82), we will administer a brief structured survey to compare those who agree to be tested vs. those who refuse with respect to similar factors described in Aim 1. Finally, semi-structured questionnaires will be administered to all pharmacy staff to qualitatively ascertain the impact of expanded services on customer base, daily business flow, and attitudes and perceptions of HIV testing services (referrals or on-site) among IDUs. Descriptive statistics and logistic regression will be used to analyze quantitative IDU data and standard qualitative techniques will be used to analyze pharmacy staff data. This proposed research is highly significant in that it aims to explore new venues for HIV testing that can reach high risk black and Hispanic communities in New York City. Due to a recently implemented expanded syringe access program allowing pharmacies to sell syringes without a prescription, a natural next step is to explore linking additional services, namely HIV testing referrals and on-site HIV testing services, with syringe sales to IDUs. If successful, this model can be duplicated not only through-out other high risk neighborhoods in New York, but in several other states with similar pharmacy access programs (e.g, New Jersey, California, Connecticut, Minnesota, Rhode Island, and Maine).
