Analysis and Mapping of Pharmacy Access to Syringes (AMPAS)

Valerie Rose, Public Health Foundation Enterprises, Inc., Emeryville; Glenn Backes, Safer Alternatives Through Networking and Education
HIV/AIDS Policy & Health Care Financing

Background: Landmark legislation (SB 1159),that permits California pharmacies to sell up to ten syringes without a prescription to anyone over the age of eighteen, was signed into law by the Governor in January 2005. The legislation also allows individuals to legally possess syringes. Although SB 1159 is a state-wide initiative, the legislation requires any interested local health department to opt in by establishing a "Disease Prevention Demonstration Project" for the sale and safe disposal of needles and syringes. To date, 13of the 61 healthjurisdictions in Californiahave established pharmacy access programs, resulting in >100 participating pharmacies throughout the State. Twenty counties are in the planning stages, and 18 have refused to adopt local programs.

Methods: This is a community collaborative project between Public Health Foundation Enterprises and the Drug Policy Alliance. The San Francisco Department of Public Health AIDS Office is an additional collaborator. Using a case study design, we will explore the factors that facilitate or inhibit local implementation of SB 1159. Naturalistic inquiry will guide qualitative data collection through in-depth interviews with county health department, needle exchange program staff and policy makers. Purposeful sampling will be used to select 10 to 15 counties with low, medium and high prevalence of HIV/AIDS among IDU. Additional criteria for selection will include counties with sanctioned, unsanctioned or no needle exchange programs, early adopters into the pharmacy access program and non-adopters of pharmacy access. In the second year of the study, we will use existing quantitative data from three to five counties to conduct geographic analysis to map the distribution of HIV/AIDS among IDU in relation to syringe access. We will map the intersection of service needs and use and create overlays of service locations, such as participating pharmacies and needle exchange sites with patterns of HIV/AIDS density by risk-group to determine if services sites are in the proximity of populations most in need. Sampling will prioritize counties that can produce appropriate data variables (e. g.,census tract level HIV/AIDS surveillance and/ or substance use treatment data).In these counties, depending on the presence of needle exchange programs and the feasibility of collecting program data from needle exchange sites, information regarding pharmacy utilization for syringe purchases will enhance the richness of the GIS mapping component. The specific aims of the study are to: (1.) enumerate policies, procedures and systems for local implementation of SB 1159 and describe the context of implementation, (2.) describe county characteristics regarding needle exchange policies and syringe disposal practices, (3.) describe facilitators, barriers and dimensions of implementation or refusal to adopt local legislation, (4.) determine the proximity of participating pharmacies in relation to high incidence IDU neighborhoods, and (5.) develop and disseminate prototypes of successful strategies and policy toolkits.

Results: Cases studies will be summarized and formatted as toolkits to illustrate best practice approaches for implementation and evaluation. Data from the case studies will provide guidance to other California counties that are currently in the planning stages for local implementation of pharmacy access to syringes. The results will provide useful information and policy strategies for counties that have experienced political opposition to local implementation. Dissemination strategies include posting results on multiple websites and providing written monographs to interested counties throughout California.