A police education programme to integrate occupational safety and HIV prevention: protocol for a modified stepped-wedge study design with parallel prospective cohorts to assess behavioural outcomes

Abstract

IntroductionPolicing practices are key drivers of HIV among people who inject drugs (PWID). This paper describes the protocol for the first study to prospectively examine the impact of a police education programme (PEP) to align law enforcement and HIV prevention. PEPs incorporating HIV prevention (including harm reduction programmes like syringe exchange) have been successfully piloted in several countries but were limited to brief pre–post assessments; the impact of PEPs on policing behaviours and occupational safety is unknown.ObjectivesProyecto ESCUDO (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 behaviours that interfere with HIV prevention and protective behaviours (secondary outcomes).Methods/analysisESCUDO is a hybrid type I 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), we will administer one 3 h PEP course to groups of 20–50 officers until the entire force is trained. NSI incidence and geocoded arrest data will be assessed from department-wide de-identified data. Of the consenting police officers, a subcohort (N=500) will be randomly sampled from each class to undergo pre-PEP and post-PEP surveys with a semiannual follow-up for 2 years to assess self-reported NSIs, attitudes and behaviour changes. The impact on PWIDs will be externally validated through a parallel cohort of Tijuana PWIDs.Ethics/disseminationResearch ethics approval was obtained from the USA and Mexico. Findings will be disseminated through open access to protocol materials through the Law Enforcement and HIV Network.Trial registration numberNCT02444403.

The effect of public health-oriented drug law reform on HIV incidence in people who inject drugs in Tijuana, Mexico: an epidemic modelling study

“…29 Between 2015 and 2016, Proyecto Escudo, a novel police education programme framed as occupational health training, was implemented to assist the enforcement of the narcomenudeo reform by shifting police knowledge, attitudes, and practices targeting people who inject drugs thereby promoting police-public health collaboration. 15 Preliminary findings suggest improved understanding of the legal status of syringe, heroin, and marijuana possession, along with better attitudes about public health-driven drug law reform. 28,30 Future work should assess the effect of this police education programme on HIV transmission in people who inject drugs.…”

“…15 Affordable and quality evidence-based drug treatment services were scarce, and in 2014, government funds were allocated to compulsory drug abstinence programmes. 16 In Tijuana, these entail physically restraining individuals, brought involuntarily by family, friends or the police, in non-medically supervised centres over 3–6 months and subjecting them to non-evidence based interventions, often involving punishment, to achieve detoxification and abstinence.…”

Assessing police officers’ attitudes and legal knowledge on behaviors that impact HIV transmission among people who inject drugs

“…Study procedures have been described previously (Strathdee et al, 2015). Briefly, from February 2015 – May 2016, over 1,800 officers received a three-and-a-half-hour police educational program (PEP) that included the following training goals: 1) occupational safety related to needlestick injuries (NSI) and HIV 2) narcomenudeo drug reform and legality of syringe possession, and 3) drug pharmacology and harm reduction services.…”

Differential experiences of Mexican policing by people who inject drugs residing in Tijuana and San Diego

“…Increased positive intergroup contact between the police and PWIDs might decrease dehumanization of PWIDs, facilitate mutual cooperation, and promote law enforcement practices that align with harm reducing public health initiatives. A training intervention-evaluation study with Tijuana Police Department is employing peer education, sensitization, multimedia, and interactive role-playing tools designed to reduce drug user stigmatization and harmonize police practice with public health; initial results are promising (Beletsky et al, 2016; Strathdee, Arredondo et al, 2015). …”