Peer-Education Intervention to Reduce Injection Risk Behaviors Benefits High-Risk Young Injection Drug Users: A Latent Transition Analysis of the CIDUS 3/DUIT Study

Abstract

We analyzed data from a large randomized HIV/HCV prevention intervention trial with young injection drug users (IDUs) conducted in five U.S. cities. The trial compared a peer education intervention (PEI) with a time-matched, attention control group. Applying categorical latent variable analysis (mixture modeling) to baseline injection risk behavior data, we identified four distinct classes of injection-related HIV/HCV risk: low risk, non-syringe equipment-sharing, moderate-risk syringe-sharing, and high-risk syringe-sharing. The trial participation rate did not vary across classes. We conducted a latent transition analysis using trial baseline and 6-month follow-up data, to test the effect of the intervention on transitions to the low-risk class at follow-up. Adjusting for gender, age, and race/ethnicity, a significant intervention effect was found only for the high-risk class. Young IDU who exhibited high-risk behavior at baseline were 90 % more likely to be in the low-risk class at follow-up after the PEI intervention, compared to the control group.

Latent Risk Subtypes Based on Injection and Sexual Behavior Among People Who Inject Drugs in Rural Puerto Rico

“…Prior LCA research has found that older age decreases the odds of high-risk class membership, relative to lowerand moderate-risk classes. 24,26 These results also support non-LCA research in which younger age was associated with risky injection 46 and sexual behavior, 47 and other factors indirectly associated with injection and sexual risk behavior among PWID including poly-substance use 48 and homelessness. 47 Taken together, the associations between age and high-risk latent class membership may be a function of younger PWID being embedded in risk environments and social networks conducive to risk behavior.…”

Intelligent Network DisRuption Analysis (INDRA): A targeted strategy for efficient interruption of hepatitis C transmissions

“…PEI applied at the level of PWID communities through randomly selected peer-educators was shown to be efficient, with 76% of PWID having continued to follow safe injection practices at least for 6 months after PEI (Garfein et al, 2007; Mackesy-Amiti et al, 2013). Given that this does not necessarily equate with a 76% effectiveness at preventing HCV transmission, this value was considered here solely as an upper bound estimate.…”

Prevalence of HIV Infection and Risk Behaviors Among Younger and Older Injecting Drug Users in the United States, 2009

“…Furthermore, interventions that place a strong emphasis on strengthening peer norms against risky injection and sex practices and that heighten perception of HIV infection risk from these behaviors may be beneficial. Peer education initiatives have demonstrated some success in influencing the behavior of IDUs [95–97], including young IDUs [98], and should be part of a comprehensive HIV prevention approach. Finally, it is important to recognize that HIV prevention efforts may also be geared toward the subset of non-injecting drug users who are at risk for transition to injection [99].…”