title: 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: BACKGROUND
  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.
  
  
  OBJECTIVE
  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
  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.
  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.
  
  
  BACKGROUND
  NCT02444403.
authors.affiliation: Department of Medicine, University of California San Diego, La Jolla, California, USA.
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
authors.affiliation: Department of Medicine, University of California San Diego, La Jolla, California, USA.
authors.forename: Jaime
authors.initials: J
authors.lastname: Arredondo
authors.affiliation: Department of Medicine, University of California San Diego, La Jolla, California, USA.
authors.forename: Teresita
authors.initials: T
authors.lastname: Rocha
authors.affiliation: Department of Medicine, University of California San Diego, La Jolla, California, USA.
authors.forename: Daniela
authors.initials: D
authors.lastname: Abramovitz
authors.affiliation: Department of Medicine, University of California San Diego, La Jolla, California, USA Xochicalco University, Tijuana, Baja California, Mexico.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Rolon
authors.affiliation: Xochicalco University, Tijuana, Baja California, Mexico.
authors.forename: Efrain
authors.initials: E
authors.lastname: Patiño Mandujano
authors.affiliation: U.S.-Mexico Border Health Commission, Mexico Section, Tijuana, Baja California, Mexico.
authors.forename: Maria Gudelia
authors.initials: MG
authors.lastname: Rangel
authors.affiliation: Secretary of Municipal Public Safety, Tijuana, Baja California, México.
authors.forename: Horcasitas Omar
authors.initials: HO
authors.lastname: Olivarria
authors.affiliation: Department of Medicine, University of California San Diego, La Jolla, California, USA.
authors.forename: Tommi
authors.initials: T
authors.lastname: Gaines
authors.affiliation: Department of Medicine, University of California San Diego, La Jolla, California, USA.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Patterson
authors.affiliation: Department of Medicine, University of California San Diego, La Jolla, California, USA School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA.
authors.forename: Leo
authors.initials: L
authors.lastname: Beletsky
mesh_terms: D015658:HIV Infections / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D035846:Law Enforcement; D008800:Mexico / Q000453:epidemiology; D018671:Needle-Exchange Programs; D016602:Needlestick Injuries / Q000453:epidemiology / Q000517:prevention & control; D009784:Occupational Diseases / Q000517:prevention & control*; D016272:Occupational Health; D016495:Police / Q000193:education* / Q000523:psychology; D011446:Prospective Studies; D015819:Substance Abuse, Intravenous / Q000150:complications
keywords: EDUCATION & TRAINING (see Medical Education & Training); EPIDEMIOLOGY; OCCUPATIONAL & INDUSTRIAL MEDICINE; PREVENTIVE MEDICINE; PUBLIC HEALTH