Presentation on theme: "CASE STUDIES OF PUBLIC HEALTH RESEARCH THAT HAVE ALTERED PUBLIC POLICY THE NEW HAVEN SEP EVALUATION."— Presentation transcript:
CASE STUDIES OF PUBLIC HEALTH RESEARCH THAT HAVE ALTERED PUBLIC POLICY THE NEW HAVEN SEP EVALUATION
HIV-1 TRANSMISSION AMONG IDUs l Behavioral risk factors include: Syringe sharing Shooting gallery attendance Sharing drugs l Behavioral risks are driven by societal factors. Fear of arrest Aversion to withdrawal Scarcity of syringes
HISTORY OF SYRINGE EXCHANGE l Syringe exchange began in Holland in response to a hepatitis outbreak. l It is impossible to say when syringe exchange first began in the US. l The first openly operating initiative began in Tacoma in 1988.
WHY A SYRINGE EXCHANGE PROGRAM IN NEW HAVEN l In contrast to national data, 70% of AIDS cases in New Haven could be attributed to injection drug use.
ESTABLISHING THE SEP IN NEW HAVEN, CONNECTICUT l The city established a task force to seek solutions to the AIDS epidemic that lobbied for three years (1987-1990) to change the laws to start a SEP. By statute, customers could exchange no more than five syringes in a strict one-for-one fashion. A evaluation report had to be produced and issued within one year. l The SEP, operated by the city health department, opened on November 13, 1990.
EVALUATING THE NEW HAVEN SEP l Minimize reliance on self-reported data. l Investigate the link between the operations of the program and its effects. l Maintain the anonymity of the participants. l Provide a timely analysis that measures the program's effectiveness.
SYRINGE TRACKING AND TESTING l All outgoing syringes coded and exchanges recorded. l All returned syringes recorded in second database. l Nearly 50,000 syringes exchanged in first three years of the SEP. l Approximately one-tenth of all returned syringes tested for presence of blood from HIV-1 infected individual.
SEP FOUND TO PREVENT NEW HIV INFECTIONS l The testing data were used to generate two models to estimate the HIV incidence rate. l The first, an ecological model, assumed that in the absence of exchange previously used syringes will be used at random. l The second, a changepoint model, assumed that sequential testing of syringes returned by individuals yields reliable longitudinal data.
MODEL 1: TRANSMISSION OF SYRINGE-BORNE INFECTIONS x x Incidence is equal to the rate at which an uninfected injector uses a potentially infectious syringe without first disinfecting it times the rate which the exposure results in infection.
THE TWO MODELS INCIDENCE ESTIMATES BASED ON THE TWO MODELS l Using model 2, the most likely incidence rate was estimated at 1.6% per year, less than half the estimate from model 1.
EFFECT OF SEP EVALUATION ON POLICY IN CONNECTICUT l In 1992, the state government reviewed the findings and Removed the “demonstration” status. Increased syringe exchange limit from 5 to 10 syringes per visit. Added five new SEPs in other cities. Allowed syringes to be purchased from pharmacies. l In 1999, the state again increased the limit on syringes from 10 to 30 per visit.
EFFECT OF SEP EVALUATION ON POLICY IN OTHER STATES l Neighboring states of New York and Massachusetts legalize SEPs. l California legislation cites New Haven studies. l Only three states continue to keep SEPs illegal. HIV Prevalence among IDUs in New York City following SEP Legalization
EFFECT OF SEP EVALUATION ON FEDERAL GOVERNMENT POLICY l U. S. government reports repeatedly certify that New Haven evaluation clearly demonstrated that SEPs can reduce HIV transmission among IDUs. l Nevertheless, Congress refuses to change law that makes federal funding of SEPs illegal. l U. S. continues to seek international disapproval of syringe exchange.