A Peer-Educator Network HIV Prevention Intervention Among Injection Drug Users: Results of a Randomized Controlled Trial in St. Petersburg, Russia

Abstract

We evaluated the efficacy of a peer-educator network intervention as a strategy to reduce HIV acquisition among injection drug users (IDUs) and their drug and/or sexual networks. A randomized controlled trial was conducted in St. Petersburg, Russia among IDU index participants and their risk network participants. Network units were randomized to the control or experimental intervention. Only the experimental index participants received training sessions to communicate risk reduction techniques to their network members. Analysis includes 76 index and 84 network participants who were HIV uninfected. The main outcome measure was HIV sero-conversion. The incidence rates in the control and experimental groups were 19.57 (95 % CI 10.74–35.65) and 7.76 (95 % CI 3.51–17.19) cases per 100 p/y, respectively. The IRR was 0.41 (95 % CI 0.15–1.08) without a statistically significant difference between the two groups (log rank test statistic X2 = 2.73, permutation p value = 0.16). Retention rate was 67 % with a third of the loss due to incarceration or death. The results show a promising trend that this strategy would be successful in reducing the acquisition of HIV among IDUs.

Preventing blood-borne virus infection in people who inject drugs in the UK: systematic review, stakeholder interviews, psychosocial intervention development and feasibility randomised controlled trial

“…'intervention included psychosocial training and skills building to teach personal risk reduction and negotiation skills' 72 and 'technical condom use and syringe disinfection skills'); 73 modelling (providing an example for people to aspire to or imitate, e.g. 'model injection and sexual risk reduction behaviors with their risk network members' 74 and 'demonstration and rehearsal of syringe cleaning and condom application'); 70 and enablement (increasing means/reducing barriers, e.g. 'women created a personalized risk reduction plan', 75 'goal-setting for HIV risk reduction and outreach' 76 and 'a short role play was then used to help her identify barriers to safer injection' 77 ).…”

“…22,[68][69][70][71][72][73]75,76,81,82,173,175,179,180,182,186,188,189,[192][193][194][195]197 The reasons for excluding eight trials from the meta-analysis were not providing the number of PWID for control and intervention groups at follow-up, 84,174,176,177,196 only providing risk ratios, 178 outcome combined HIV infections with sexually transmitted infections 77 and data for 'unsafe injection practices' were presented only at baseline. 74 …”

“…In total, 12,840 participants (35% female, range 0-100%) were enrolled in the trials; the majority were PWID (84.5%) (the proportion of participants enrolled in the trials who were PWID ranged from 16% to 100%). The majority (n = 18) of trials were conducted in the USA, 22,68,[70][71][72]76,81,84,174,176,177,179,182,186,189,193,195,196 three were conducted in Russia, 74,75,194 two were conducted in Canada, 175,178 two were conducted in Vietnam, 82,180 one was conducted in Kazakhstan, 73 one was conducted in Georgia, 188 one was conducted in Australia, 197 one was conducted in the UK, 173 one was conducted in Mexico, 77 one was conducted in Puerto Rico 192 and one was conducted in both the USA and Thailand. 69 Trials included in the systematic review compared psychosocial interventions with usual care (n = 4), 22,68,178,195 education or information (n = 9), 70,76,77,175,176,180,188,…”

“…69 Trials included in the systematic review compared psychosocial interventions with usual care (n = 4), 22,68,178,195 education or information (n = 9), 70,76,77,175,176,180,188,196,197 HIV infection testing and counselling (n = 5), 69,82,84,192,193 interventions of lesser time or intensity with OST (n = 12) [72][73][74]81,173,174,177,179,182,190,194 and without OST (n = 2). 71,186 Of the 32 interventions delivered in the RCTs included in the systematic review, most (n = 14) were delivered to individual participants, 22,68,70,71,75,77,81,173,175,178,192,[195][196][197] eight were delivered to groups of participants 69...…”

“…84,177 The remaining eight trials delivered interventions in more than one way (e.g. individual and couples sessions, 187,188 individual and group sessions, 69,76,186,190,194 Records identified from electronic database searches ( Samet 2015 194 Rotheram-Borus 2010 193 Robles 2004 192 Purcell 2007 189 Otiashvili 2012 188 McMahon 2013 84 Margolin 2003 Hoffman 2013 74 Go 2015 82 Go 2013 180 Gilbert 2010 73 Garfein 2007 179 Gagnon 2010 178 El-Bassell 2011 177 Dushay 2001 ) and one trial provided both individual-and structural-level activities. 82 For interventions with more than one session, retention or adherence to the intervention ranged from 50% 68 to 95%.…”