16th International AIDS Conference Toronto, Canada - August 13 - 18, 2006

DEMONSTRATED EFFICACY OF A PEER-MENTORING INTERVENTION TO REDUCE HIGH RISK INJECTION BEHAVIORS AMONG YOUNG HCVINFECTED IDUS: THE STUDY TO REDUCE INTRAVENOUS EXPOSURES (STRIVE)

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. TuAc0305

S. Strathdee¹, H. Hagan², E. Golub³, F. Kapadia⁴, J. Campbell⁵, R. Garfein¹, D. Thomas⁶, S. Bonner⁴, T. King Thiel⁷, M. Latka⁴, STRIVE Project
¹UCSD, Division of International Health and Cross Cultural Medicine, San Diego, United States, ²NDRI, New York, United States, ³Johns Hopkins University, Epidemiology, Baltimore, United States, ⁴New York Academy of Medicine, New York, United States, ⁵Metro King County Health Department, Seattle, United States, ⁶Johns Hopkins University, Medicine, Baltimore, United States, ⁷Hepatitis Foundation International, Washington, United States

BACKGROUND: Since HCV is hyper-endemic among injection drug users (IDUs) and usually precedes HIV infection, interventions to prevent secondary HCV transmission may prevent HIV acquisition. We evaluated the efficacy of a multi-center behavioral intervention to reduce distribution of used injection equipment (i.e., needles/syringes, cookers, cottons, rinse-water) among HCV-positive IDUs.

METHODS: 418 HCV-positive, HIV-negative IDUs aged 18-35 years recruited in Baltimore, MD; New York, NY; Seattle, WA were randomly assigned to receive a Peer Mentoring Intervention (PMI, n=222) or a time-equivalent attention-control Video Discussion Intervention (VDI, n=196). Participants completed behavioral assessments using audio computer-assisted self-interview (ACASI) at baseline, three and six-month follow-up visits; 86% attended at least one follow-up visit. Behavioral outcomes included the proportion of injections involving HIV/HCV transmission-associated practices among PMI versus VDI participants at follow-up, adjusted for relevant baseline covariates.

RESULTS: Participants were 76% male, 57% white, 7% African-American, 27% Hispanic and averaged 27 years-old. At 3 months, compared to the VDI, the PMI was associated with more than two-fold risk reductions in: receptive sharing of needles/syringes, sharing of cookers, cottons and rinse-water and a composite measure of injection risks (all p<0.05). At 6 months, these associations waned slightly but most remained significant; the PMI was associated with a 78% decrease in self-reported injection risks relative to baseline (adjusted odds ratio=0.22; 95% CI: 0.12 – 0.42). At both time-points, compared to the VDI, participants randomized to the PMI scored significantly higher on measures of self-efficacy related to safer injection behaviors.

CONCLUSIONS: Our peer mentoring intervention was significantly associated with reductions in HIV/HCV transmission-associated injection behaviors among IDUs in three U.S. cities. Most risk reductions were maintained after six months and behavior changes appeared to be mediated through increases in self-efficacy. This intervention has significant promise in reducing the spread of HCV and HIV among young IDUs who continue to practice high-risk injection behaviors.

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2006-08-13
TuAc0305

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