Clinical Trial: Police Training to Reduce Occupational Needlesticks and HIV Among Substance Users

Study Status: Recruiting
Recruit Status: Recruiting
Study Type: Interventional

Official Title: Proyecto ESCUDO: Police Training to Reduce Occupational Needlesticks and HIV Among Substance Users

Brief 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, attitude

Detailed Summary:

The Police Education Program (PEP) and its evaluation component, has been titled Proyecto ESCUDO (Project SHIELD). This project has the following aims: 1) To evaluate the efficacy of the PEP on uptake of occupational safety procedures, as assessed through the incidence of occupational needle-stick injury (NSI) (primary outcome), monitored by a department-wide NSI surveillance program, and self-reported NSI; 2) To evaluate the efficacy of the PEP on changes in the following secondary outcomes: i) knowledge of transmission, prevention and treatment of HIV and related infections (sexually transmitted infections (STIs) and viral hepatitis); ii) attitudes towards people who inject drugs (PWID); iii) adverse behaviors that interfere with HIV prevention (i.e., arrests near syringe exchange programs (SEP) and drug treatment locations); iv) protective behaviors (e.g., use of barrier protection, self-reported reductions in syringe confiscation). 3) To assess potential mediating and moderating factors that influence PEP efficacy, including changes in knowledge and attitudinal factors and occupational constructs. 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 (OST) and SEPs).

Hypotheses:

H1. The PEP will be associated with a significant decline in NSI incidence among the force during follow-up.

H2.1. The PEP will be associated with significantly increased knowledge of transmission, prevention and treatment of HIV and HCV among Tijuana police officers partic
Sponsor: University of California, San Diego

Current Primary Outcome: Incidence of Occupational Needle Stick Injuries [ Time Frame: 3 years ]

• The number of incident NSIs reported by each police officer, under the surveillance system. Cumulative NSI incidence will be measured over a three year period to accommodate the implementation of the step-wedge design intervention framework.


Original Primary Outcome: Same as current

Current Secondary Outcome:

  • HIV Knowledge [ Time Frame: 0, 3, 6, 12, 18 and 24 months ]
    Knowledge score: knowledge of transmission, prevention and treatment of HIV and related infections (STIs and viral hepatitis).
  • Attitudinal and behavior changes [ Time Frame: 0, 3, 6, 12, 18 and 24 months ]
    Attitudes score: attitudes towards PWID, sex workers and HIV-infected persons.
  • Adverse behaviors that interfere with HIV prevention [ Time Frame: 0, 3, 6, 12, 18 and 24 months ]
    Self-reporting of adverse behaviors that interfere with HIV prevention (i.e. syringe confiscation and syringe-related arrests) and Tijuana police department geo-coded arrest data will be used to determine the rate of arrests that occur near SEP and drug treatment programs, pre- and post-PEP.
  • Protective behaviors [ Time Frame: 2 years ]
    Self-reporting of protective behaviors for HIV prevention (i.e. use of gloves as barrier protection during pat-downs and arrests, self-reported reductions in syringe confiscation) and Tijuana police department geo-coded arrest data will be used to determine the extent to which the PEP decreases the number of arrests near SEP and OST sites in Tijuana, pre- and post-PEP.


Original Secondary Outcome:

  • HIV Knowledge [ Time Frame: 2 years ]
    Knowledge of transmission, prevention and treatment of HIV and related infections (STIs and viral hepatitis). Knowledge score from pre-PEP training, post-PEP training, 3-, 6-, 12-, 18-, and 24-months post-PEP training.
  • Attitudinal and behavior changes [ Time Frame: 2 years ]
    Attitudes towards PWID, sex workers and HIV-infected persons. Attitudes score from pre-PEP training, post-PEP training, 3-, 6-, 12-, 18-, and 24-months post-PEP training.
  • Adverse behaviors that interfere with HIV prevention [ Time Frame: 2 years ]
    Self-reporting of adverse behaviors that interfere with HIV prevention (i.e. syringe confiscation and syringe-related arrests) and Tijuana police department geo-coded arrest data will be used to determine the rate of arrests that occur near SEP and drug treatment programs, pre- and post-PEP.
  • Protective behaviors [ Time Frame: 2 years ]
    Self-reporting of protective behaviors for HIV prevention (i.e. use of gloves as barrier protection during pat-downs and arrests, self-reported reductions in syringe confiscation) and Tijuana police department geo-coded arrest data will be used to determine the extent to which the PEP decreases the number of arrests near SEP and OST sites in Tijuana, pre- and post-PEP.


Information By: University of California, San Diego

Dates:
Date Received: May 12, 2015
Date Started: June 2015
Date Completion:
Last Updated: May 10, 2016
Last Verified: May 2016