Mediation of peer education intervention effects on injection-related HIV risk behavior among male Tajik labor migrants

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Abstract
Introduction: The effects of network-based peer education interventions for HIV prevention presumably influence injection-related risk behavior through changes in peer norms and safer injection self-efficacy (SISE). In this paper, we test these mediating effects on receptive syringe sharing (RSS) and ancillary equipment sharing. Methods: The “Migrants’ Approached Self-Learning Intervention in HIV/AIDS for Tajiks” (MASLIHAT) intervention was tested in Moscow in a cluster-randomized controlled trial in comparison with a non-HIV health education training (TANSIHAT). Tajik migrants who inject drugs (N=140) were recruited as peer educators (PEs) to attend the 5-session MASLIHAT training or the TANSIHAT comparison condition. In both conditions, participants recruited two network members who inject drugs with the intent to share with them the information and positive strategies for change they had learned (n=280). PEs and network members in both conditions (n=420) participated in baseline and follow-up interviews at 3-month intervals for one year. We conducted causal mediation analyses to test the direct and indirect effects of intervention arm and psychosocial variables on injection practices. Results: MASLIHAT participants reported greater HIV knowledge, greater SISE, and safer descriptive and injunctive peer norms at 3-month follow-up compared to TANSIHAT participants. In the MASLIHAT arm only, greater HIV knowledge was associated with lower odds of RSS, and greater SISE and safer descriptive peer norms were associated with lower odds of both RSS and equipment sharing at 6-month follow-up. Injunctive peer norms were not associated with either outcome. Causal mediation analysis indicated that treatment effects were mediated by SISE and descriptive peer norms; however the distributions of responses on peer norms were problematic. Conclusions: The MASLIHAT intervention had a strong effect on SISE and descriptive peer norms for safer injection, and these variables were significantly associated with injection risk behaviors at 6-month follow-up. Analysis results are consistent with mediation, however estimates may be sensitive to model assumptions because of restricted overlap in mediator distributions between treatment conditions.
Funding Information
  • National Institute on Drug Abuse (R01DA050464)

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