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A peer-education intervention to reduce injection risk behaviors for HIV and hepatitis C virus infection in young injection drug users

Garfein, Richard Sa,g; Golub, Elizabeth Tb; Greenberg, Alan Ea,i; Hagan, Hollyc; Hanson, Debra La; Hudson, Sharon Md; Kapadia, Farzanae; Latka, Mary He; Ouellet, Lawrence Jf; Purcell, David Wa; Strathdee, Steffanie Ag; Thiede, Hanneh; for the DUIT Study Team

doi: 10.1097/QAD.0b013e32823f9066
Epidemiology and Social

Objectives: To evaluate whether a behavioral intervention, which taught peer education skills, could reduce injection and sexual risk behaviors associated with primary HIV and hepatitis C virus infection (HCV) among young injection drug users (IDU).

Design: We conducted a randomized controlled trial involving HIV and HCV antibody-negative IDU, aged 15–30 years, recruited in five United States cities. A six-session, small-group, cognitive behavioral, skills-building intervention in which participants were taught peer education skills (n = 431) was compared with a time-equivalent attention control (n = 423). Baseline visits included interviews for sociodemographic, psychosocial, and behavioral factors during the previous 3 months; HIV and HCV antibody testing; and pre/posttest counselling. Procedures were repeated 3 and 6 months postintervention.

Results: The intervention produced a 29% greater decline in overall injection risk 6 months postintervention relative to the control [proportional odds ratio 0.71; 95% confidence limit (CL) 0.52, 0.97], and a 76% decrease compared with baseline. Decreases were also observed for sexual risk behaviors, but they did not differ by trial arm. Overall HCV infection incidence (18.4/100 person-years) did not differ significantly across trial arms (relative risk 1.15; 95% CL 0.72, 1.82). No HIV seroconversions were observed.

Conclusion: Interventions providing information, enhancing risk-reduction skills, and motivating behavior change through peer education training can reduce injection risk behaviors, although risk elimination might be necessary to prevent HCV transmission.

From the aDivision of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

bJohns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA

cNational Research and Development Institutes, New York, New York, USA

dHealth Research Association, Los Angeles, California, USA

eNew York Academy of Medicine, Center for Urban Epidemiologic Studies, New York, New York, USA

fUniversity of Illinois at Chicago, School of Public Health, Chicago, Illinois, USA

gUniversity of California San Diego, School of Medicine, San Diego, California, USA

hPublic Health Seattle and King County, Seattle, Washington, USA

iGeorge Washington University, School of Public Health and Health Services, Washington, DC, USA.

Received 12 October, 2006

Revised 30 March, 2007

Accepted 11 April, 2007

Correspondence to Richard S. Garfein, PhD, MPH, Division of International Health and Cross Cultural Medicine, Department of Family and Preventive Medicine, University of California San Diego, School of Medicine, 9500 Gilman Drive, Mail Code 0622, San Diego, CA 92093-0622, USA. Tel: +1 858 822 3018; fax: +1 858 534 4642; e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.