The Rapid HIV Test in Spanish Pharmacies: A Novel Program to Reach Heterosexual Men?

OBJECTIVES:

Spain has been a pioneer in the implementation of rapid HIV testing programmes in pharmacies to increase access to testing. However, no formal evaluation of the effectiveness of these programmes has been carried out to date. Our aim was to evaluate the ability of a novel in-pharmacy rapid HIV testing programme to promote diagnosis and reach vulnerable populations.

METHODS:

Between 2011 and 2012, 2168 people underwent testing in 16 urban pharmacies in 10 cities of a Spanish region with a low prevalence of HIV infection. The main outcomes of the programme were compared with those of the regional surveillance system for new HIV diagnoses (RHSS-CyL).

RESULTS:

Overall, 52.8% of those tested were heterosexual men, 15.8% were men who have sex with men (MSM) and 25.3% were women. Nine per cent were immigrants and 41.9% were < 30 years old. In total, 59.5% of the heterosexual men, 44.6% of the MSM and 65.3% of the women were previously untested. There were 23 positive results, representing 6% of all new regional diagnoses in 2011. The global prevalence was 1.1% (95% confidence interval 0.6-1.5%) and the prevalence in MSM was 3.8%. Of the reactive results, 60.9% were in MSM, 34.8% in heterosexual men and only 4.3% in women, vs. 35.4%, 37.5% and 15.0%, respectively, reported by the RHSS-CyL. The mean age of those testing positive was 32.7 years vs. 38.7 years in the RHSS-CyL. Fifty per cent of MSM and 75% of heterosexual men testing positive were previously untested.

CONCLUSIONS:

In Spain, this is the first programme not targeted at the most at-risk populations, and has been shown to be effective in reaching and diagnosing heterosexual men, who are the group most affected by delayed diagnoses. Heterosexual men accounted for over half of those tested and a third of those diagnosed, and most of them were previously untested. Young and previously untested MSM also greatly benefitted from the programme.

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By:  Fernández-Balbuena S1,2, Marcos H3, Pérez-Rubio A3, Hoyos J1,2, Belza MJ2,4, de la Fuente L1,2.

• 1National Epidemiology Centre, Carlos III Health Institute, Madrid, Spain.
• 2CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
• 3Epidemiological Surveillance Service, Public Health Directorate, Regional Ministry of Health of Castilla and León, Valladolid, Spain.
• 4National School of Health, Carlos III Health Institute, Madrid, Spain. 
• HIV Med. 2015 Jul;16(6):362-9. doi: 10.1111/hiv.12224. Epub 2015 Feb 17.

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Establishing a Link Between Prescription Drug Abuse and Illicit Online Pharmacies: Analysis of Twitter Data

BACKGROUND:

Youth and adolescent non-medical use of prescription medications (NUPM) has become a national epidemic. However, little is known about the association between promotion of NUPM behavior and access via the popular social media microblogging site, Twitter, which is currently used by a third of all teens.

OBJECTIVE:

In order to better assess NUPM behavior online, this study conducts surveillance and analysis of Twitter data to characterize the frequency of NUPM-related tweets and also identifies illegal access to drugs of abuse via online pharmacies.

METHODS:

Tweets were collected over a 2-week period from April 1-14, 2015, by applying NUPM keyword filters for both generic/chemical and street names associated with drugs of abuse using the Twitter public streaming application programming interface. Tweets were then analyzed for relevance to NUPM and whether they promoted illegal online access to prescription drugs using a protocol of content coding and supervised machine learning.

RESULTS:

A total of 2,417,662 tweets were collected and analyzed for this study. Tweets filtered for generic drugs names comprised 232,108 tweets, including 22,174 unique associated uniform resource locators (URLs), and 2,185,554 tweets (376,304 unique URLs) filtered for street names. Applying an iterative process of manual content coding and supervised machine learning, 81.72% of the generic and 12.28% of the street NUPM datasets were predicted as having content relevant to NUPM respectively. By examining hyperlinks associated with NUPM relevant content for the generic Twitter dataset, we discovered that 75.72% of the tweets with URLs included a hyperlink to an online marketing affiliate that directly linked to an illicit online pharmacy advertising the sale of Valium without a prescription.

CONCLUSIONS:

This study examined the association between Twitter content, NUPM behavior promotion, and online access to drugs using a broad set of prescription drug keywords. Initial results are concerning, as our study found over 45,000 tweets that directly promoted NUPM by providing a URL that actively marketed the illegal online sale of prescription drugs of abuse. Additional research is needed to further establish the link between Twitter content and NUPM, as well as to help inform future technology-based tools, online health promotion activities, and public policy to combat NUPM online.

Below:  Word cloud for generic instance

Below:  Word cloud for street instance

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By:   Katsuki T1, Mackey TK, Cuomo R.

• 1Kavli Institute for Brain and Mind (http://kibm.ucsd.edu/), University of California, San Diego, La Jolla, CA, United States.
• J Med Internet Res. 2015 Dec 16;17(12):e280. doi: 10.2196/jmir.5144.

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The Potential for Screening for Intimate Partner Violence in Community Pharmacies: An Exploratory Study of Female Consumers' Perspectives

Intimate partner violence (IPV) is a substantial public health problem. The U.S. Preventive Services Task Force recently updated guidelines to recommend IPV screening for all women of childbearing age. Expansion of screening efforts to the community pharmacy setting could provide an opportunity to substantially impact the health of consumers. 

To date, no research has explored consumers' perspective on IPV screening in the community pharmacy environment. To address this gap, a descriptive survey research study was conducted to examine female consumers' attitudes and preferences for IPV screening in community pharmacies. Female pharmacy customers (N = 60) completed an online survey assessing knowledge of and attitudes about community pharmacies as sources of health care advice, beliefs about IPV and IPV screening, and perspectives on IPV screening in the community pharmacy environment. 

Consumers who utilized pharmacies with more patient care services were more likely to report interest in IPV screening in the pharmacy environment. The majority of respondents thought IPV screening is an important thing to do (85.0%), and 33.3% agreed that it should happen in a pharmacy. A statistically significant relationship between the belief that the pharmacy is a good place for health education and preference for IPV screening in the community pharmacy environment was found, r(58) = .43, p < .001. 

Concern regarding the time required to conduct screenings and about the availability of appropriate space were identified as potential barriers to screening in the pharmacy environment.

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By: Barnard M1, West-Strum D2, Holmes E2, Yang Y2, Fisher A2.

• 1The University of Mississippi, Oxford, USA mbarnard@olemiss.edu.
• 2The University of Mississippi, Oxford, USA. 

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Cost Analysis of a Novel HIV Rapid Testing Strategy in Community Pharmacies & Retail Clinics

To document the cost of implementing point-of-care (POC) human immunodeficiency virus (HIV) rapid testing in busy community pharmacies and retail clinics. Providing HIV testing services in community pharmacies and retail clinics is an innovative way to expand HIV testing. The cost of implementing POC HIV rapid testing in a busy retail environment needs to be documented to provide program and policy leaders with adequate information for planning and budgeting.

Cost analysis from a pilot project that provided confidential POC HIV rapid testing services in community pharmacies and retail clinics.

The pharmacy sites were operated under several different ownership structures (for-profit, nonprofit, sole proprietorship, corporation, public, and private) in urban and rural areas. We included data from the initial six sites that participated in the project. We collected the time spent by pharmacy and retail clinic staff for pretest and posttest counseling in an activity log for time-in-motion for each interaction.

The total cost was calculated to include costs of test kits, control kits, shipping, test supplies, training, reporting, program administration, and advertising.

The six sites trained 22 staff to implement HIV testing. 

• A total of 939 HIV rapid tests were conducted over a median time of 12 months, of which 17 were reactive. 
• Median pretest counseling time was 2 minutes. 
• Median posttest counseling time was 2 minutes for clients with a nonreactive test and 10 minutes for clients with a reactive test. 
• The average cost per person tested was an estimated $47.21. 
• When we considered only recurrent costs, the average cost per person tested was $32.17.

Providing POC HIV rapid testing services required a modest amount of staff time and costs that are comparable to other services offered in these settings. 

HIV testing in pharmacies and retail clinics can provide an additional alternative venue for increasing the availability and accessibility of HIV testing services in the United States.

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By: Fernández-Montero JV1, Barreiro P2, de Mendoza C3, Labarga P4, Soriano V2.

• 1Department of Infectious Diseases, Crosshouse University Hospital, Kilmarnock, UK.
• 2Infectious Diseases Unit, La Paz University Hospital, Madrid, Spain.
• 3Department of Internal Medicine, Puerta de Hierro Research Institute & University Hospital, Majadahonda, Madrid, Spain.
• 4Department of Internal Medicine, La Luz Clinic, Madrid, Spain.

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Widening the Access to HIV Testing: The Contribution of Three In-Pharmacy Testing Programmes in Spain

Below:  Distribution of the participating pharmacies on three rapid HIV testing programmes

45.7% were heterosexual men (MSW), 14.4% men who have sex with men (MSM), and 27% women. The 35% were younger than 30 and 9.6% foreigners. The 52% were previously untested, and women were the most likely to be untested. The three programmes altogether diagnosed 226 people, resulting in a global prevalence of 0.9% (95%CI: 0.8–1.1); 3.4% in MSM (95%CI: 2.8–4.0). The prevalence among Spaniards was 0.8% (0.7–1.0) vs. 2.2 (1.6–2.9) among foreigners. The percentages of MSM diagnosed by all three programmes were higher than the one reported by their respective RHSS. Thirty four percent of the reactive MSM and the 71.4% of the reactive MSW did not have a previous HIV test although big testing history differences were observed across the programmes. Altogether, these services contributed with the 10.6% of all HIV diagnoses in these regions.

In-pharmacy HIV testing programmes are a valuable testing option, having been able to uncover 1 out of 10 the new diagnoses reported in each region. They showed a good capacity of reaching and diagnosing previously untested populations, not only a priority population such as MSM but also heterosexual population who are more affected by delayed diagnosis. They seem to be particularly suitable for regions without large cities and specific HIV diagnostic services.

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