title: Evaluating the impact of Mexico's drug policy reforms on people who inject drugs in Tijuana, B.C., Mexico, and San Diego, CA, United States: a binational mixed methods research agenda.
abstract: BACKGROUND
  Policymakers and researchers seek answers to how liberalized drug policies affect people who inject drugs (PWID). In response to concerns about the failing "war on drugs," Mexico recently implemented drug policy reforms that partially decriminalized possession of small amounts of drugs for personal use while promoting drug treatment. Recognizing important epidemiologic, policy, and socioeconomic differences between the United States-where possession of any psychoactive drugs without a prescription remains illegal-and Mexico-where possession of small quantities for personal use was partially decriminalized, we sought to assess changes over time in knowledge, attitudes, behaviors, and infectious disease profiles among PWID in the adjacent border cities of San Diego, CA, USA, and Tijuana, Baja California, Mexico.
  
  
  METHODS
  Based on extensive binational experience and collaboration, from 2012-2014 we initiated two parallel, prospective, mixed methods studies: Proyecto El Cuete IV in Tijuana (n = 785) and the STAHR II Study in San Diego (n = 575). Methods for sampling, recruitment, and data collection were designed to be compatible in both studies. All participants completed quantitative behavioral and geographic assessments and serological testing (HIV in both studies; hepatitis C virus and tuberculosis in STAHR II) at baseline and four semi-annual follow-up visits. Between follow-up assessment visits, subsets of participants completed qualitative interviews to explore contextual factors relating to study aims and other emergent phenomena. Planned analyses include descriptive and inferential statistics for quantitative data, content analysis and other mixed-methods approaches for qualitative data, and phylogenetic analysis of HIV-positive samples to understand cross-border transmission dynamics.
  
  
  RESULTS
  Investigators and research staff shared preliminary findings across studies to provide feedback on instruments and insights regarding local phenomena. As a result, recruitment and data collection procedures have been implemented successfully, demonstrating the importance of binational collaboration in evaluating the impact of structural-level drug policy reforms on the behaviors, health, and wellbeing of PWID across an international border.
  
  
  CONCLUSIONS
  Our prospective, mixed methods approach allows each study to be responsive to emerging phenomena within local contexts while regular collaboration promotes sharing insights across studies. The strengths and limitations of this approach may serve as a guide for other evaluations of harm reduction policies internationally.
authors: Angela M
authors: AM
authors: Robertson
authors: Richard S
authors: RS
authors: Garfein
authors: Karla D
authors: KD
authors: Wagner
authors: Sanjay R
authors: SR
authors: Mehta
authors: Carlos
authors: C
authors: Magis-Rodriguez
authors: Jazmine
authors: J
authors: Cuevas-Mota
authors: Patricia Gonzalez
authors: PG
authors: Moreno-Zuniga
authors: Division of Global Public Health, School of Medicine, University of California at San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0507, USA. sstrathdee@ucsd.edu.
authors: Steffanie A
authors: SA
authors: Strathdee
mesh_terms: D000293:Adolescent; D000328:Adult; D002140:California / Q000453:epidemiology; D003376:Counseling; D003415:Crime / Q000331:legislation & jurisprudence; D004641:Emigration and Immigration / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control; D018166:Health Care Reform / Q000331:legislation & jurisprudence; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy / Q000331:legislation & jurisprudence; D019698:Hepatitis C, Chronic / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007880:Legislation, Drug; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D016485:Needle Sharing; D018671:Needle-Exchange Programs; D015995:Prevalence; D011446:Prospective Studies; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control; D055815:Young Adult