A peer-education intervention to reduce injection risk behaviors for HIV and hepatitis C virus infection in young injection drug users

George Washington University, Washington, Washington, D.C., United States
AIDS (Impact Factor: 5.55). 10/2007; 21(14):1923-32. DOI: 10.1097/QAD.0b013e32823f9066
Source: PubMed


To evaluate whether a behavioral intervention, which taught peer education skills, could reduce injection and sexual risk behaviors associated with primary HIV and hepatitis C virus infection (HCV) among young injection drug users (IDU).
We conducted a randomized controlled trial involving HIV and HCV antibody-negative IDU, aged 15-30 years, recruited in five United States cities. A six-session, small-group, cognitive behavioral, skills-building intervention in which participants were taught peer education skills (n = 431) was compared with a time-equivalent attention control (n = 423). Baseline visits included interviews for sociodemographic, psychosocial, and behavioral factors during the previous 3 months; HIV and HCV antibody testing; and pre/posttest counselling. Procedures were repeated 3 and 6 months postintervention.
The intervention produced a 29% greater decline in overall injection risk 6 months postintervention relative to the control [proportional odds ratio 0.71; 95% confidence limit (CL) 0.52, 0.97], and a 76% decrease compared with baseline. Decreases were also observed for sexual risk behaviors, but they did not differ by trial arm. Overall HCV infection incidence (18.4/100 person-years) did not differ significantly across trial arms (relative risk 1.15; 95% CL 0.72, 1.82). No HIV seroconversions were observed.
Interventions providing information, enhancing risk-reduction skills, and motivating behavior change through peer education training can reduce injection risk behaviors, although risk elimination might be necessary to prevent HCV transmission.

Download full-text


Available from: Hanne Thiede
  • Source
    • "We only considered what was reported at study enrollment since there was little variation over time among these covariates. Due to skip patterns in questionnaire items measuring substance use behavior among those who had not injected drugs between follow-up visits, we only included what was reported at baseline for the following: heroin, methamphetamine and cocaine use in the month prior to study enrollment, drug use with clients in the month prior to study enrollment , and a continuous measure of safer injection self-efficacy previously developed by a U.S. intervention study (Garfein et al., 2007). Covariates that varied over the study period included housing status, injection frequency, income outside of sex work, healthcare access, drug treatment, police confiscation of drug paraphernalia, increased police presence, incarceration, and a continuous measure of condom use self-efficacy previously developed by a Mexico intervention study (Patterson et al., 2008a). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: This study quantitatively examined the prevalence and correlates of short-term sex work cessation among female sex workers who inject drugs (FSW-IDUs) and determined whether injection drug use was independently associated with cessation. Methods: We used data from FSW-IDUs (n=467) enrolled into an intervention designed to increase condom use and decrease sharing of injection equipment but was not designed to promote sex work cessation. We applied a survival analysis that accounted for quit-re-entry patterns of sex work over 1-year stratified by city, Tijuana and Ciudad Juarez, Mexico. Results: Overall, 55% of participants stopped sex work at least once during follow-up. Controlling for other characteristics and intervention assignment, injection drug use was inversely associated with short-term sex work cessation in both cities. In Ciudad Juarez, women receiving drug treatment during follow-up had a 2-fold increase in the hazard of stopping sex work. In both cities, income from sources other than sex work, police interactions and healthcare access were independently and significantly associated with shorter-term cessation. Conclusions: Short-term sex work cessation was significantly affected by injection drug use. Expanded drug treatment and counseling coupled with supportive services such as relapse prevention, job training, and provision of alternate employment opportunities may promote longer-term cessation among women motivated to leave the sex industry.
    Full-text · Article · Jun 2015 · Addictive Behaviors
  • Source
    • "For example, in this study, less than half of the men reported unprotected sex with casual partners at baseline. When we consider this, it is not surprising that the initial analysis [23] did not find a significant intervention effect. A more nuanced analysis strategy is needed to assess changes on multiple dimensions. "
    [Show abstract] [Hide abstract]
    ABSTRACT: We analyzed data from a large randomized HIV/HCV prevention intervention trial with young injection drug users (IDUs). Using categorical latent variable analysis, we identified distinct classes of sexual behavior for men and women. We conducted a latent transition analysis to test the effect of the intervention on transitions from higher to lower risk classes. Men who were in a high-risk class at baseline who received the intervention were 86 % more likely to be in a low-risk class at follow-up compared to those in the control group (p = 0.025). High-risk intervention participants were significantly more likely to transition to the class characterized by unprotected sex with a main partner only, while low-risk intervention participants were significantly less likely to transition to that class. No intervention effect was detected on the sexual risk behavior of women, or of men who at baseline were having unprotected sex with a main partner only. Electronic supplementary material The online version of this article (doi:10.1007/s10461-013-0601-2) contains supplementary material, which is available to authorized users.
    Full-text · Article · Aug 2013 · AIDS and Behavior
  • Source
    • "In addition to the success of peer interventions on reducing risk behaviors among IDU, two articles reported a reduction in injection risk behavior among young IDU who received training to become peer outreach workers [3,21]. Additionally, Garfein et al. (2007) showed fewer instances of unprotected sex among participants of a peer education intervention at six months follow-up compared to the control baseline [3]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Health policies and programs are increasingly being driven by people from the community to more effectively address their needs. While a large body of evidence supports peer engagement in the context of policy and program development for various populations, little is known about this form of engagement among people who use drugs (PWUD). Therefore, a narrative literature review was undertaken to provide an overview of this topic. Searches of PubMed and Academic Search Premier databases covering 1995--2010 were conducted to identify articles assessing peer engagement in policy and program development. In total, 19 articles were included for review. Our findings indicate that PWUD face many challenges that restrict their ability to engage with public health professionals and policy makers, including the high levels of stigma and discrimination that persist among this population. Although the literature shows that many international organizations are recommending the involvement of PWUD in policy and program development, our findings revealed a lack of published data on the implementation of these efforts. Gaps in the current evidence highlight the need for additional research to explore and document the engagement of PWUD in the areas of policy and program development. Further, efforts to minimize stigmatizing barriers associated with illicit drug use are urgently needed to improve the engagement of PWUD in decision making processes.
    Full-text · Article · Nov 2012 · Substance Abuse Treatment Prevention and Policy
Show more