Impact Evaluation of a Policy Intervention for HIV Prevention in Washington, DC.

Monica S. Ruiz,Sean T. Allen,Allison O’Rourke

doi:10.1007/s10461-015-1143-6

Monica S. Ruiz, Sean T. Allen + Show 1 more

Open Access

https://doi.org/10.1007/s10461-015-1143-6

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Journal: AIDS and Behavior	Publication Date: Sep 4, 2015
Citations: 43	License type: CC BY 4.0

Affiliation: Milken Institute, George Washington University

Abstract

Syringe exchange programs (SEPs) lower HIV risk. From 1998 to 2007, Congress prohibited Washington, DC, from using municipal revenue for SEPs. We examined the impact of policy change on IDU-associated HIV cases. We used surveillance data for new IDU-associated HIV cases between September 1996 and December 2011 to build an ARIMA model and forecasted the expected number of IDU-associated cases in the 24 months following policy change. Interrupted time series analyses (ITSA) were used to assess epidemic impact of policy change. There were 176 IDU-associated HIV cases in the 2 years post-policy change; our model predicted 296 IDU-associated HIV cases had the policy remained in place, yielding a difference of 120 averted HIV cases. ITSA identified significant immediate (B = −6.0355, p = .0005) and slope changes (B = −.1241, p = .0427) attributed to policy change. Policy change is an effective structural intervention for HIV prevention when it facilitates the implementation of services needed by vulnerable populations.

Highlights

The District of Columbia (DC) is in the midst of a significant HIV/AIDS epidemic [1]
Syringe exchange is an example of a structural intervention that could have a tremendous impact on HIV prevention among people who inject drugs (PWID)
Using the autoregressive integrated moving averages (ARIMA) model fitted to the pre-implementation data, we developed a forecast of the number of expected cases for each of the 24 months following the interruption

Summary

Introduction

The District of Columbia (DC) is in the midst of a significant HIV/AIDS epidemic [1]. According to epidemiological data from the end of 2011, approximately 2.4 % of DC residents over the age of 12 years are living with HIV/ AIDS [1]. Injection drug use (IDU) accounts for 14.2 % of the living cases of HIV/AIDS in the District [1]. HIV transmission through IDU disproportionately affects women and African-Americans, and the problem is most common in Washington’s most economically disadvantaged areas. The scientific community has put increased attention on the need for interventions that better address the social drivers of HIV risk [2]. Syringe exchange is an example of a structural intervention that could have a tremendous impact on HIV prevention among people who inject drugs (PWID)

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