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

BMJ Open, Vol. 5, Issue 8, Article e008958 (2015)

Northeastern University School of Law Research Paper No. 243-2015

Posted: 28 Oct 2015 Last revised: 29 Oct 2015

See all articles by Steffanie A. Strathdee

Steffanie A. Strathdee

University of California, San Diego (UCSD) - Division of Infectious Diseases and Global Public Health

Jaime Arredondo

University of California, San Diego – School of Medicine, Division of Global Public Health

Teresita Rocha

University of California, San Diego - School of Medicine, Division of Global Public Health

Daniela Abramovitz

University of California, San Diego – School of Medicine, Division of Global Public Health

Maria Rolon

University of California, San Diego - School of Medicine, Division of Global Public Health

Efrain Mandujano

Xochicalco University

Gudelia Rangel

affiliation not provided to SSRN

Horcasitas Olivarria

Secretary of Municipal Public Safety, Tijuana, Baja California, México

Tommi Gaines

University of California, San Diego – School of Medicine, Division of Global Public Health

Thomas L. Patterson

University of California, San Diego (UCSD)

Leo Beletsky

Northeastern University - School of Law; Northeastern University - Bouvé College of Health Sciences; Division of Infectious Disease and Global Public Health, UCSD School of Medicine

Date Written: August 25, 2015

Abstract

Introduction Policing 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.

Objectives Proyecto 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/Analysis ESCUDO 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/Dissemination Research 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.

Strengths and Limitations of This Study Proyecto ESCUDO is one of the few interventions attempting to alter the law enforcement environment for infectious disease transmission, and the first study to prospectively examine the impact of a police education programme (PEP) to align law enforcement and HIV prevention.

Although the study design precludes randomising officers to receive the training, the use of a modified stepped wedge design is novel and ideally suited for cases like this when an intervention is presumed to do more good than harm, it is logistically impractical to offer the intervention simultaneously to all participants, and the study outcomes do not require an overly long follow-up.

The use of geocoded arrest data obtained through collaboration with the Tijuana police will allow for objectively determining the extent to which the PEP is associated with changing arrest patterns.

Suggested Citation

Strathdee, Steffanie A. and Arredondo, Jaime and Rocha, Teresita and Abramovitz, Daniela and Rolon, Maria and Mandujano, Efrain and Rangel, Gudelia and Olivarria, Horcasitas and Gaines, Tommi and Patterson, Thomas L. and Beletsky, Leo, 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 (August 25, 2015). BMJ Open, Vol. 5, Issue 8, Article e008958 (2015); Northeastern University School of Law Research Paper No. 243-2015. Available at SSRN: https://ssrn.com/abstract=2650743

Steffanie A. Strathdee (Contact Author)

University of California, San Diego (UCSD) - Division of Infectious Diseases and Global Public Health ( email )

La Jolla, CA
United States

Jaime Arredondo

University of California, San Diego – School of Medicine, Division of Global Public Health ( email )

9500 Gilman Drive
MC 0507
La Jolla, CA 92093
United States

Teresita Rocha

University of California, San Diego - School of Medicine, Division of Global Public Health ( email )

Daniela Abramovitz

University of California, San Diego – School of Medicine, Division of Global Public Health ( email )

9500 Gilman Drive
MC 0507
La Jolla, CA 92093
United States

Maria Rolon

University of California, San Diego - School of Medicine, Division of Global Public Health ( email )

Efrain Mandujano

Xochicalco University ( email )

Calle Novena 1199
Plutarco Elías Calles
Tijuana, Mexicali, B.C. 21376
Mexico

Gudelia Rangel

affiliation not provided to SSRN

Horcasitas Olivarria

Secretary of Municipal Public Safety, Tijuana, Baja California, México ( email )

300 N Coal St
Tijuana, 65265
Mexico

Tommi Gaines

University of California, San Diego – School of Medicine, Division of Global Public Health ( email )

9500 Gilman Drive
MC 0507
La Jolla, CA 92093
United States

Thomas L. Patterson

University of California, San Diego (UCSD) ( email )

9500 Gilman Drive
Mail Code 0502
La Jolla, CA 92093-0112
United States

Leo Beletsky

Northeastern University - School of Law; Northeastern University - Bouvé College of Health Sciences ( email )

416 Huntington Avenue
Boston, MA 02115
United States
617-373-5540 (Phone)

Division of Infectious Disease and Global Public Health, UCSD School of Medicine ( email )

9500 Gilman Drive
MC 0507
La Jolla, CA 92093
United States

Register to save articles to
your library

Register

Paper statistics

Abstract Views
242
PlumX Metrics