* noted as presenting author
Anne Brisson, PhD, Director of Operations, Columbia University, New York, NY, Nabila El-Bassel, DSW, Professor, Columbia University, New York, NY, Danil Nikitin, Project Director, Global Health Research Center of Central Asia, New York, NY, Leyla Ismayilova, PhD, Post-Doctoral Research Scientist, Columbia University, New York, NY and Louisa Gilbert, PhD, Co-Director, Columbia University, New York, NY
BACKGROUND & PURPOSE: This presentation presents the adaptation process and preliminary outcomes of the Self-Help in Eliminating Life-threatening Diseases (SHIELD) intervention for injection drug users and their risk network in the Southern Kyrgyzstan region of Osh. The Osh region was chosen for intervention as half of all known HIV cases in the country are in this region and among IDU, 14% HIV+ and 50% with HCV. Osh is a low-resource setting with limited substance abuse treatment programs and of the estimated 5,000 IDU in Osh (this is 1.6% of the population), less than 2,000 have some contact with the health care system or harm reduction organizations. It was therefore important to identify an intervention that could gain access to the hidden IDU population and be sustainable in this setting. This intervention was selected by a joint US-Central Asia research team as it could empower IDU to develop skills and knowledge to decrease their own HIV risk behavior and also share this knowledge with their sexual and drug risk network. The SHIELD intervention is a cognitive behavior and social influence peer education training program consisting of theory-based exercises and activities and outreach training. Behavior change is targeted at the individual injection drug user level and also at the group norm level.
METHODS: This study included two components, 1) qualitative phase to adapt the intervention, and 2) pilot the intervention with 30 index participants and 30 network members (total of 60 participants). For the pilot component, we implemented the manualized six-session intervention through four cohorts. A total of 30 male IDU were trained as index participants and each IDU recruited a risk network member (total participants was 60, including 50 men and 10 women). The network member was someone with whom the index participant had unprotected sex or unsafe injection practices within the past 30 days. Measures for all 60 participants were collected at baseline, immediate post, and one-month post.
RESULTS: Through the adaptation process we learned key ingredients of intervention content, and also recruitment and retention strategies. The main HIV risk behavior identified among the long-term heroin users in this study is unsafe injecting practices, as while condom use is low among this group the number of sexual partners and sexual behavior is also low. Pre-post analysis reported significant reduction in HIV drug risk behavior, including less sharing of syringes and unsterile injecting equipment. Pre-post analysis also reported an increase in likelihood of future safe sexual and drug risk behavior, and increased communication about HIV among index participants and their network members.
CONCLUSIONS & IMPLICATIONS: Overall, the participants embraced the intervention and valued the opportunity to learn peer education skills and to share this with their risk network. The revised SHIELD intervention has potential promise in this environment and will be further tested with a randomized clinical trial.
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