Peer-driven HIV interventions for drug injectors in Russia: First year impact results of a field experiment

We report impact results on the first operating year of an HIV prevention field experiment for injection drug users (IDUs) in two cities in western Russia, comparing a Standard "peer-driven intervention" (PDI) in Bragino to a Simplified-PDI in Rybinsk. The PDI relies on IDUs to educate one another in the community about HIV prevention, and recruit peers for enhanced prevention services and education. In the Standard-PDI, IDU-recruiters are offered nominal monetary rewards for both recruiting peers and educating them in a body of prevention information. In the Simplified-PDI, IDU-recruiters are similarly asked to educate and recruit their peers, but the reward for recruiting is woven into their education efforts. This modification streamlined the model's operations and made it 50% less expensive to operate in respondent fees. The overarching research question is whether the modification in the PDI's reward structure affects the model's recruitment power and educational effectiveness. First year results indicate that both PDIs achieved high baseline recruitment rates, although the Standard-PDI out-performed the Simplified-PDI by approximately 35% (493 recruits versus 365 recruits, respectively). However, the IDU-recruiters in the Simplified-PDI did a significantly better job educating their recruits at both baseline (an average knowledge test score of 5.19 versus 4.07 on an 8-point scale) and at follow-up 6 months later (an average knowledge test score of 7.21 versus 5.56 on an 8-point scale). Both PDIs demonstrated about equal and significant efficacy in reducing respondents' injection frequency, the sharing of syringes and other equipment, and rates of unprotected sex. Two additional refinements in the PDI model were also documented: an enhanced follow-up mechanism more than doubled the PDI's retention strength (to approximately 75%), and clear demonstration that IDUs are capable of educating their recruits in two different bodies of prevention information, depending on whether the recruits are new or follow-up participants. (c) 2006 Elsevier B.V. All rights reserved.