Randomized, Community-Based Pharmacy Intervention to Expand Services Beyond Sale of Sterile Syringes to Injection Drug Users in Pharmacies in New York City

摘要

Structural interventions may help reduce racial/ethnic disparities in HIV. In 2009 to 2011, we randomized pharmacies participating in a nonprescription syringe access program in minority communities to intervention (pharmacy enrolled and delivered HIV risk reduction information to injection drug users [IDUs]), primary control (pharmacy only enrolled IDUs), and secondary control (pharmacy did not engage IDUs). Intervention pharmacy staff reported more support for syringe sales than did control staff. An expanded pharmacy role in HIV risk reduction may be helpful. Evidence supports the efficacy of both structural interventions targeting policy, organizational, and other sociocontextual factors and multilevel interventions targeting both individual and structural factors. 1–3 However, few robust studies of this type of intervention have contributed to the HIV literature. 4,5 Amelioration of persistent racial disparities in HIV/AIDS may require structural and multilevel interventions in heavily burdened communities. 5,6 The New York State Expanded Syringe Access Program (ESAP), a structural-level HIV prevention strategy that began in 2001 and allows nonprescription syringe sales in pharmacies to help reduce HIV transmission among injection drug users (IDUs), demonstrated improved access to sterile syringes, 7 safe syringe disposal, 8,9 and reduced syringe sharing. 10 Minority IDUs, however, have less access to ESAP. 6,11–14 The Pharmacies as Resources Making Links to Community Services intervention, a large-scale, randomized structural intervention targeting community members, pharmacy staff, and IDUs patronizing pharmacies in New York City neighborhoods with high proportions of minorities and significant drug activity, began in 2009. 5 We investigated the impact of this intervention on pharmacy staff support of (1) ESAP, (2) in-pharmacy HIV testing, and (3) in-pharmacy vaccination.