Modeling the Impact of a Police Education Program on HIV Incidence Among People Who Inject Drugs

Principal Investigator: Javier Cepeda, PhD, MPH
Project Number: K01DA043421
Police have been recognized worldwide as an integral component of the HIV risk environment because their behaviors can elevate HIV risk among people who inject drugs (PWID).  In Tijuana, policing behaviors such as syringe confiscation and arrest have been associated with unsafe injection practices and HIV seropositivity among PWID.  HIV prevention interventions, such as police education programs (PEP) that align policing with public health practices (e.g. referral to harm reduction services instead of arrest) may help in reducing HIV incidence.  This study will leverage findings from two parallel cohort studies – Proyecto Escudo, which delivered a public health-oriented PEP to over 1,800 officers in Tijuana and is now following a sub-sample to examine the impact of the PEP on policing behaviors and El Cuete, a prospective cohort of PWID living in Tijuana.  We will employ methods in economic evaluation and dynamic infectious disease modeling to realize the following specific aims:
Aim 1: To model the cost-effectiveness of the police education program, including both individual and population prevention benefits on the HIV epidemic among PWID
Aim 2: To model the potential impact of increased police referrals to harm reduction services (syringe exchange programs and opioid substitution therapy) on HIV incidence among PWID
Aim 3: To explore how increased police referral of PWID to syringe exchange programs and opioid substitution therapy could improve the overall cost-effectiveness of the police education program
This project will enable us to provide recommendations to program and government officials on the value-for-money of the PEP including impact on HIV incidence among PWID, and how to improve cost-effectiveness. These findings will be highly relevant to Tijuana and other cities in Mexico experiencing HIV epidemics fueled by injection drug use.  The cost-effectiveness and transmission modeling will assess the impact of the PEP, a structural intervention to change policing attitudes and behaviors, incorporating prevention benefits through both direct pathways of structural drivers of HIV transmission (police behavior and syringe confiscation/arrest) and indirect pathways (changes in policing that may alter syringe exchange program/opioid substitution therapy utilization).