Smith Laramie R, Strathdee Steffanie A, Metzger David, Latkin Carl
Division of Global Public Health, University of California San Diego, UCSD School of Medicine, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA.
Department of Psychiatry, University of Pennsylvania and The Treatment Research Institute, Perelman School of Medicine, 3400 Civic Center Boulevard, Bldg. 421, Philadelphia, PA, 19104, USA.
Drug Alcohol Depend. 2017 Jun 1;175:164-170. doi: 10.1016/j.drugalcdep.2017.02.007. Epub 2017 Apr 5.
Little is known about ways network-level factors that may influence the adoption of combination prevention behaviors among injection networks, or how network-oriented interventions might moderate this behavior change process.
A total of 232 unique injection risk networks in Philadelphia, PA, were randomized to a peer educator network-oriented intervention or standard of care control arm. Network-level aggregates reflecting the injection networks' baseline substance use dynamics, social interactions, and the networks exposure to gender- and structural-related vulnerabilities were calculated and used to predict changes in the proportion of network members adopting safer injection practices at 6-month follow-up.
At follow-up, safer injection practices were observed among 46.31% of a network's members on average. In contrast, 25.7% of networks observed no change. Controlling for the effects of the intervention, significant network-level factors influencing network-level behavior change reflected larger sized injection networks (b=2.20, p=0.013) with a greater proportion of members who shared needles (b=0.29, p<0.001) and engaged in poly drug use at baseline (b=6.65, p=0.021). Changes in a network's safer injection practices were also observed for networks with fewer new network members (b=-0.31, p=0.008), and for networks whose members were proportionally less likely to have experienced incarceration (b=-0.20, p=0.012) or more likely to have been exposed to drug treatment (b=0.17, p=0.034) in the 6-months prior to baseline. A significant interaction suggested the intervention uniquely facilitated change in safer injection practices among female-only networks (b=-0.32, p=0.046).
Network-level factors offer insights into ways injection networks might be leveraged to promote combination prevention efforts.
关于可能影响注射网络中联合预防行为采用的网络层面因素，以及以网络为导向的干预措施如何调节这种行为改变过程，我们所知甚少。
宾夕法尼亚州费城共有232个独特的注射风险网络被随机分配到同伴教育者网络导向干预组或护理标准对照组。计算反映注射网络基线物质使用动态、社会互动以及网络暴露于性别和结构相关脆弱性的网络层面汇总指标，并用于预测在6个月随访时采用更安全注射做法的网络成员比例的变化。
随访时，平均有46.31%的网络成员采用了更安全的注射做法。相比之下，25.7%的网络没有变化。在控制干预效果后，影响网络层面行为改变的显著网络层面因素包括规模较大的注射网络（b = 2.20，p = 0.013），基线时共用针头的成员比例较高（b = 0.29，p < 0.001）以及多药使用的成员比例较高（b = 6.65，p = 0.021）。对于新网络成员较少的网络（b = -0.31，p = 0.008），以及在基线前6个月内成员经历监禁的比例较低（b = -0.20，p = 0.012）或接受药物治疗的可能性较高（b = 0.17，p = 0.034）的网络，也观察到了网络更安全注射做法的变化。显著的交互作用表明，干预措施独特地促进了仅女性网络中更安全注射做法的改变（b = -0.32，p = 0.046）。
网络层面因素为如何利用注射网络促进联合预防努力提供了见解。
