Outcomes of a Peer HIV Prevention Program with Injection Drug and Crack Users: The Risk Avoidance Partnership

Institute for Community Research, Hartford, Connecticut 06106, USA.
Substance Use & Misuse (Impact Factor: 1.23). 02/2009; 44(2):253-81. DOI: 10.1080/10826080802347677
Source: PubMed


The Risk Avoidance Partnership (RAP) Project conducted in Hartford, Connecticut, tested a program to train active drug injectors and crack cocaine users as "Peer Health Advocates" (PHAs) to deliver a modular HIV, hepatitis, and STI prevention intervention to hard-to-reach drug users in their networks and others in the city. The intervention was designed to diffuse health promotion and risk-reduction interventions by supporting PHAs to model prevention practices and deliver risk- and harm-reduction materials and information. We compared change in behaviors and attitudes between baseline and 6-month follow-up of 112 primarily African-American and Latino PHAs, 223 of their drug-user network contact referrals, and 118 other study recruits (total n = 523). Results indicated significant HIV risk reduction among all study participants, associated with significant health advocacy action conducted by PHAs, and a relationship between exposure to the RAP peer-delivered intervention and risk reduction among all study groups. Findings suggest that active drug users' engagement in peer health advocacy can set in motion a feedback and diffusion process that supports both the continued work of the PHAs and the adoption of harm reduction and mimicking of health advocacy by their peers.

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    • "The addition of a well-specified peer support component has the potential to improve cessation outcomes for several reasons. Peer support is well established in the treatment of other addictions and health conditions (Kaskutas, 2009; Webel, Okonsky, Trompeta, & Holzemer, 2010; Weeks et al., 2009). In addition, peer services have increasingly assumed an important role in mental health services for persons with serious mental illness (Chinman et al., 2014; Davidson, Chinman, Sells, & Rowe, 2006; Green, Janoff, Yarborough, & Paulson, 2013; Resnick, Armstrong, Sperrazza, Harkness, & Rosenheck, 2004; Salzer, Schwenk, & Brusilovskiy, 2010). "
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    ABSTRACT: Objective: We evaluated a well-specified peer mentor program that enhanced a professionally led smoking cessation group for persons with serious mental illnesses. Method: Participants were 8 peer mentors, persons with serious mental illnesses who had successfully quit smoking, and 30 program participants, persons with serious mental illnesses enrolled in a 6-month intervention. Peer mentors were trained and then helped to deliver a smoking cessation group and met with program participants individually. We assessed the mentors' skills after training, their fidelity to the model, and the program's feasibility and acceptability. We also measured the smoking outcomes of the program participants including change in exhaled carbon monoxide, a measure of recent smoking, and aspects of the peer mentor-program participant relationship. Results: Peer mentors attained a mean score of 13.6/14 on role play assessments after training and delivered the intervention with fidelity as assessed by adherence and competence ratings (mean scores of 97% and 93%, respectively). The feasibility and acceptability of the intervention was demonstrated in that 28/30 participants met with their peer mentors regularly and only 1 participant and no peer mentor discontinued in the study. Both parties rated the interpersonal alliance highly, mean of 5.9/7. The program participants had a decline in carbon monoxide levels and number of cigarettes smoked per day (repeated measures ANOVA F = 6.04, p = .008; F = 15.87, p < .001, respectively). A total of 22/30 (73%) made a quit attempt but only 3 (10%) achieved sustained abstinence. Conclusions and implications for practice: Our study adds to the growing literature about peer-delivered interventions. (PsycINFO Database Record
    Full-text · Article · Oct 2015 · Psychiatric Rehabilitation Journal
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    • "A peer-driven HIV prevention intervention ('Risk Avoidance Partnership') reduced drug use (p = 0.001) and sex-risk outcomes (p = 0.010) at 6-months follow-up in a sample of n = 523 drug injectors and/or inhalers (including a majority of crack users); improvements in attitude outcomes were also observed. There were no major outcome differences between the peer-health advocates delivering the intervention and intervention participants (Weeks et al., 2009). An experimental ('Safety Counts') HIV prevention intervention , compared to a standard NIDA intervention, resulted in greater reductions in sexual activity (effect size ration ( "
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    ABSTRACT: There are an estimated several million crack-cocaine users globally; use is highest in the Americas. Most crack users are socio-economically marginalized (e.g., homeless), and feature elevated risks for morbidity (e.g., blood-borne viruses), mortality and crime/violence involvement, resulting in extensive burdens. No comprehensive reviews of evidence-based prevention and/or treatment interventions specifically for crack use exist. We conducted a comprehensive narrative overview of English-language studies on the efficacy of secondary prevention and treatment interventions for crack (cocaine) abuse/dependence. Literature searches (1990-2014) using pertinent keywords were conducted in main scientific databases. Titles/abstracts were reviewed for relevance, and full studies were included in the review if involving a primary prevention/treatment intervention study comprising a substantive crack user sample. Intervention outcomes considered included drug use, health risks/status (e.g., HIV or sexual risks) and select social outcome indicators. Targeted (e.g., behavioral/community-based) prevention measures show mixed and short-term effects on crack use/HIV risk outcomes. Material (e.g., safer crack use kit distribution) interventions also document modest efficacy in risk reduction; empirical assessments of environmental (e.g., drug consumption facilities) for crack smokers are not available. Diverse psycho-social treatment (including contingency management) interventions for crack abuse/dependence show some positive but also limited/short-term efficacy, yet likely constitute best currently available treatment options. Ancillary treatments show little effects but are understudied. Despite ample studies, pharmaco-therapeutic/immunotherapy treatment agents have not produced convincing evidence; select agents may hold potential combined with personalized approaches and/or psycho-social strategies. No comprehensively effective 'gold-standard' prevention/treatment interventions for crack abuse exist; concerted research towards improved interventions is urgently needed. Copyright © 2015 Elsevier B.V. All rights reserved.
    Full-text · Article · Jan 2015 · International Journal of Drug Policy
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    • "Facilitators also reported improving their own injection practices following the IS Team education campaign. This is consistent with examinations of peer leaders within larger social network interventions showing that peers involved in education and outreach report the greatest reductions in injection risk behaviours after a follow-up period [27,28,30,53,54]. The results of this study suggest that employing non-users in prevention and intervention work restricts IDU from receiving the aforementioned benefits of this type of work, while evidence indicates that they may in fact be the most suitable candidates to deliver educational messages. "
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    ABSTRACT: Background Unsafe injection practices play a major role in elevated rates of morbidity and mortality among people who inject drugs (IDU). There is growing interest in the direct involvement of IDU in interventions that seek to address unsafe injecting. This study describes a drug user-led safer injecting education campaign, and explores facilitators’ experiences delivering educational workshops. Methods We conducted semi-structured qualitative interviews with 8 members of the Injection Support (IS) Team who developed and facilitated a series of safer injecting education workshops. Interviews explored facilitator’s perceptions of the workshops, experiences being a facilitator, and perspectives on the educational campaign. Interviews were transcribed verbatim and a thematic analysis was conducted. Results IS Team facilitators described how the workshop’s structure and content enabled effective communication of information about safer injecting practices, while targeting the unsafe practices of workshop participants. Facilitators’ identity as IDU enhanced their ability to relate to workshop participants and communicate educational messages in language accessible to workshop participants. Facilitators reported gaining knowledge and skills from their involvement in the campaign, as well as positive feelings about themselves from the realization that they were helping people to protect their health. Overall, facilitators felt that this campaign provided IDU with valuable information, although facilitators also critiqued the campaign and suggested improvements for future efforts. Conclusions This study demonstrates the feasibility of involving IDU in educational initiatives targeting unsafe injecting. Findings illustrate how IDU involvement in prevention activities improves relevance and cultural appropriateness of interventions while providing individual, social, and professional benefits to those IDU delivering education.
    Full-text · Article · Mar 2013 · Harm Reduction Journal
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