This application addresses the broad Challenge Area (01) Behavior, Behavioral Change, and Prevention and the specific Challenge Topic, 01-DA-106: Development of behavioral and social interventions that reduce stigma and improve quality and accessibility of health care services in low resource settings. We will evaluate a pharmacy-based pilot intervention that combines rapid HIV testing with other preventive screening services including blood pressure, glucose, and cholesterol screening. This pilot targeted to injection drug users (IDUs) who purchase syringes from pharmacies via the New York State Expanded Syringe Access Program (ESAP) - a program aimed at increasing sterile syringe access to help reduce HIV transmission. By combining HIV testing with less stigmatizing screening services and offering testing to all pharmacy patrons instead of singling out drug users, the likelihood of reducing HIV testing and drug use-associated stigma will increase. Although HIV testing is increasingly accessible and new testing technologies are available, HIV testing rates are low in the black and Hispanic community, especially among IDUs at risk for HIV and many other infectious and chronic diseases. Structural barriers (i.e., lack of health insurance) in the black and Hispanic community, especially among IDUs may limit access to regular health care/ preventive services. Access barriers are compounded by stigma associated with getting an HIV test that may identify an individual as a drug user and/or someone who engages in socially unacceptable behavior. Thus, this proposed study aims to 1) qualitatively evaluate HIV testing and chronic disease screening in pharmacies, 2) compare/contrast correlates of agreeing to a HIV test vs. not among IDU syringe customers and their peers and 3) qualitatively compare/contrast HIV testing with comprehensive screening services pharmacy (intervention) vs. HIV testing only pharmacy (control). To accomplish these aims, we propose to conduct in-depth interviews among key stakeholders to inform development of study materials, IDU/peer survey and pharmacy staff surveys. We will recruit 2 ESAP-registered Harlem pharmacies (1 intervention and 1 control) where our current work has developed the infrastructure to perform on-site screening services. Among the intervention and control pharmacies, 798 (518 non-drug using, 70 drug-using +3 networks/ drug user) pharmacy customers will be recruited. We will adapt a previously developed training module to train pharmacy personnel on how to engage pharmacy customers. Customers from the intervention pharmacy will complete a brief attitude scale on attitudes toward HIV, IDUs and stigma, watch an educational video on the importance of health screening (particularly HIV testing), participate in desired screening services and undergo a structured 20-minute ACASI that repeats the attitudes scale. Customers in the control pharmacy will only undergo HIV testing and a structured 20-minute ACASI survey. Semi-structured surveys will be administered to all pharmacy staff to ascertain impact of on-site prevention services on pharmacy personnel and business flow. We will use standard qualitative analytic techniques and GEE to account for clustering in quantitative analyses. The proposed research is highly significant in that it aims to explore a pilot intervention that involves expanding pharmacy services to include HIV testing and to determine if offering HIV testing within a comprehensive prevention approach that includes less stigmatizing screening tests (i.e., blood pressure, glucose and cholesterol screening) increases HIV testing among injection drug users who purchase syringes in pharmacies and their peers (drug-using and/or non-drug using). We will be using new HIV testing technologies and bringing technological innovations and treatment modalities to low-income communities in New York City. If successful, this model can be duplicated not only throughout other high-risk neighborhoods in New York, but in several other cities and states. If our findings are positive, broader public health impact could follow. Pharmacists can partner with clinicians and other health care providers to offer an integrative approach to HIV testing to high-risk injection drug using populations and to other groups with limited access to health care services such as the uninsured and undocumented immigrants. Adoption of this integrative approach to HIV testing on a larger scale could also be implemented and reduce many of the access and stigmatization barriers experienced in marginalized populations for HIV testing while simultaneously increasing and improving general health and well-being by targeting chronic disease outcomes that disproportionately affect marginalized populations.
The proposed research is highly significant in that it aims to explore a pilot intervention that involves expanding pharmacy services to include HIV testing and to determine if offering HIV testing within a comprehensive prevention approach that includes less stigmatizing screening tests (i.e., blood pressure, glucose and cholesterol screening) increases HIV testing among injection drug users who purchase syringes in pharmacies and their peers (drug-using and/or non-drug using). We will be using new HIV testing technologies and bringing technological innovations and treatment modalities to low-income communities in New York City. If successful, this model can be duplicated not only throughout other high-risk neighborhoods in New York, but in several other cities and states. If our findings are positive, broader public health impact could follow. Pharmacists can partner with clinicians and other health care providers to offer an integrative approach to HIV testing to high-risk injection drug using populations and to other groups with limited access to health care services such as the uninsured and undocumented immigrants. Adoption of this integrative approach to HIV testing on a larger scale could also be implemented and reduce many of the access and stigmatization barriers experienced in marginalized populations for HIV testing while simultaneously increasing and improving general health and well-being by targeting chronic disease outcomes that disproportionately affect marginalized populations.
| Crawford, Natalie D; Dean, Trevano; Rivera, Alexis V et al. (2016) Pharmacy Intervention to Improve HIV Testing Uptake Using a Comprehensive Health Screening Approach. Public Health Rep 131 Suppl 1:139-46 |
| Rivera, Alexis V; DeCuir, Jennifer; Crawford, Natalie D et al. (2015) Factors associated with HIV stigma and the impact of a nonrandomized multi-component video aimed at reducing HIV stigma among a high-risk population in New York City. AIDS Care 27:772-6 |
| Rivera, Alexis V; DeCuir, Jennifer; Crawford, Natalie D et al. (2014) Internalized stigma and sterile syringe use among people who inject drugs in New York City, 2010-2012. Drug Alcohol Depend 144:259-64 |
| Crawford, Natalie D; Vlahov, David (2010) Progress in HIV reduction and prevention among injection and noninjection drug users. J Acquir Immune Defic Syndr 55 Suppl 2:S84-7 |
