Police Training to Reduce Occupational Needlesticks and HIV Among Substance Users

Summary

Background: Policing practices are key drivers of HIV among people who inject drugs (PWID). This study prospectively examines the impact of a police education program (PEP) to align law enforcement and HIV prevention. PEPs incorporating HIV prevention, (including harm reduction programs like syringe exchange) have been successfully piloted in several countries but were limited to brief pre-post assessments; the impact of PEPs on policing behaviors and occupational safety is unknown. Objectives: Proyecto ESCUDO (Project SHIELD) aims to evaluate the efficacy of the PEP on uptake of occupational safety procedures, as assessed through the incidence of needle stick injuries (NSIs) (primary outcome) and changes in knowledge of transmission, prevention and treatment of HIV and viral hepatitis; attitudes towards PWID, adverse behaviors that interfere with HIV prevention, and protective behaviors (secondary outcomes). The investigators hypothesize that, over the course of the 24-month follow-up, the PEP will be associated with significant declines in NSI incidence, improved knowledge of HIV and related infections, uptake of occupational safety measures, and decreases in behaviors that undermine HIV prevention (e.g. syringe confiscation, police harassment of PWID at opioid substitution therapy and syringe exchange programs). Methods/Design: ESCUDO is a Hybrid Type 2 design that simultaneously tests an intervention and an implementation strategy. Using a modified stepped-wedge design involving all active duty street-level police officers in Tijuana (N= \~1200), the investigators will administer one 3-hour PEP course to groups of 20-50 officers until the entire force is trained. NSI incidence and geo-coded arrest data will be assessed from department-wide de-identified data. Of consenting police officers, a sub-cohort (N=500) will be randomly sampled from each class to undergo pre- and post-PEP surveys with semi-annual follow-up for 2 years to assess self-reported NSIs, attitudes and behavior changes. Impact on PWIDs will be externally validated through a parallel cohort of Tijuana PWIDs. Discussion: This is the first trial to assess efficacy of a PEP on policing behaviors that place PWID and police at elevated risk of HIV and blood-borne infections. Findings may help bring PEPs to scale in the growing number of countries where policing is a documented driver of HIV acquisition.

Conditions

• Occupational Needlestick Injuries

Interventions

BEHAVIORAL

Police Education Program designed to align law enforcement and HIV prevention in Tijuana

The 3.5-hour PEP course consists of 3 modules. Module I covers basic epidemiology, prevention and treatment of HIV, viral hepatitis and STIs, safe syringe disposal and fundamentals of addiction. Post-exposure protocols and appropriate follow-up procedures are outlined. Module II covers key provisions of Mexico's national drug policy (narcomenudeo, which defines amounts of drugs allowed for personal possession), as well as other legal provisions pertinent to HIV prevention, including the legality of syringe and condom possession. Module III covers public health-based interventions targeting PWID (SEPs, OST) and deconstructs myths typical among law enforcement (i.e., drug users do not care about their health, SEPs increase the risk of NSIs). A sub-cohort sample will be invited to undergo pre- and post-PEP surveys with semi-annual follow-up for 2 years to assess self-reported NSIs (Aim 1), attitudinal and behavior changes (Aim 2) and mediators/moderators (Aim 3).

Sponsors & Collaborators

• National Institute on Drug Abuse (NIDA)

  collaborator NIH

• Open Society Foundations

  collaborator UNKNOWN

• UCSD Center for AIDS Research (CFAR)

  collaborator UNKNOWN

• Mexico-U.S. Border Health Commission, Mexico section

  collaborator UNKNOWN

• University of California, San Diego

  lead OTHER

Principal Investigators

• Steffanie A Strathdee, PhD · Associate Dean of Global Health Sciences, Harold Simon Professor, Chief, Division of Global Public Health, University of California San Diego, Department of Medicine

• Leo Beletsky, JD, MPH · Associate Professor of Law and Health Sciences, School of Law & Bouvé College of Health Sciences, Northeastern University, Adjunct Professor, Division of Global Public Health, University of California San Diego Department of Medicine

Study Design

Allocation

NA

Purpose

PREVENTION

Masking

NONE

Model

SINGLE_GROUP

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2015-06-30

Primary Completion

2018-05-29

Completion

2018-05-29

Countries

• Mexico

Study Locations