Evaluation of a peer network intervention trial among young methamphetamine users in Chiang Mai, Thailand

Abstract

Since the 1990s, there has been a proliferation of methamphetamine use in Thailand, particularly among young people. Simultaneously, risky sexual behaviors among this population have increased. This study examined the effects of a peer network intervention and a life skills intervention on methamphetamine and HIV risk behaviors among 18-25 year olds in Chiang Mai, Thailand. Between April 2005 and June 2007, we conducted a randomized behavioral trial to compare the efficacy of a peer educator, network-oriented intervention with a best practice, life-skills curriculum on methamphetamine use, sexual behaviors, and incident sexually transmitted infections (STIs). Followup occurred at three, six, nine, and twelve months. Both conditions consisted of seven, two hour, small group sessions. Longitudinal analyses of the three outcomes were conducted by fitting repeated measures logistic regression models using generalized estimating equations. Participants (N=983) attended a median of six sessions, with no differences between arms. At each follow-up visit, retention was greater than 85%. Participants were 75% male and were a median of 19 years old. Over time, participants in both conditions showed a significant and dramatic decline in self-reported methamphetamine use (99% at baseline versus 53% at 12-months, p<0.0001) and significant increase in consistent condom use (32% baseline versus 44% at 12 months, p<0.0001). Incident STIs were common, with no differences between arms. Chlamydia had the highest incidence rate, 9.85/100 person-years and HIV had a low incidence rate of 0.71/100 person-years. Among young Thais, we found that a peer educator, network-oriented intervention was associated with reductions in methamphetamine use, increases in condom use, and reductions in incident STIs over 12 months. We also found parallel reductions with the life skills condition. To our knowledge, this is the first such trial targeting this population. Small group interventions are an effective means of reducing methamphetamine use and sexual risk among Thai youth.

Peer‐led interventions to prevent tobacco, alcohol and/or drug use among young people aged 11–21 years: a systematic review and meta‐analysis

“…In this programme (ASSIST), ‘peer supporters’ communicated smoking prevention messages informally to their friends as part of their usual social interactions. The same model has effectively underpinned other studies targeting sexual risk behaviour 26, the use of contraception 59, cardiovascular disease prevention 60 and drug use 61, suggesting that there may be scope for further investigation of the use and effectiveness of this approach, particularly where it involves the activation and harnessing of peer networks.…”

Methamphetamine-Related Disorders

“…The recommendation for the nutritional supplements is based mainly on their low risk, rather than on any robust evidence of benefit: in a placebo-controlled RCT involving 60 patients, depressive manifestations as measured on the Inventory of Depressive Symptomatology-Clinician Rating (IDS-C) fell from 38.8 and 37.8 points at baseline in the drug and placebo groups, respectively, to 26.2 and 33.1 points at the end of the study (p = 0.05) (21). Psychoeducation and exercise therapy have been found effective and should be offered (17,23).…”

Validation and application of hair analysis for the detection of methamphetamine in young Thai adults

“…These participants were voluntarily participating in a larger research program that attempted to evaluate the effects of peernetwork intervention on drug abuse and on risk-taking sexual behavior [6]. The hair specimens were collected from participants who reported consuming MA at least 3 times during the previous 3 months.…”

“…The validated method was applied to detect MA in 1,111 hair samples of young Thai adults, 18−25 years old, who admitted using yaba at least 3 times within the 3 months before having their hair cut for the study [6]. Seventy-five percent of the participants were male.…”

“…Although the MA purity of yaba tablets is generally estimated at approximately 20% [1], the actual MA content of yaba tablets consumed by study participants is unknown. The study took place immediately following a severe crackdown on illicit drugs by Thai authorities [6], and it is possible that some participants ingested tablets containing no MA at all. These various circumstances may have resulted in unintentional over-reporting of drug use and the consumed dosages of MA may have been too low to yield test results above the protocol's cutoff.…”