Department of Medicine, University of Washington, Seattle, Washington, United States of America.
Department of Epidemiology, University of Washington, Seattle, Washington, United States of America.
PLoS One. 2022 Dec 1;17(12):e0278210. doi: 10.1371/journal.pone.0278210. eCollection 2022.
In Kenya, harm reduction organizations have adopted evidence-based peer educator (PE) programs, where former people who inject drugs (PWID) serve as community health liaisons to engage PWID in HIV, HCV and harm reduction services. While PEs play an integral role in healthcare delivery, little data exists on their roles, risks and experiences working with PWID, which may be used to inform local harm reduction policy.
PE's from two harm reduction sites in Nairobi were randomly and purposively selected to participate in semi-structured in-depth interviews. Thematic analysis was conducted to characterize the expected versus actual roles that PEs employ while serving PWID, personal motivation and/or challenges and occupational health risks. Data was analyzed using Atlas.ti software.
Twenty PEs participated in the study. On average, PEs were 37 years of age, with 3 years of service. Female representation was 30%. Expected responsibilities included locating clients, establishing rapport, educating and escorting clients to addiction care facilities. Additional roles included attending to clients outside of work hours, escorting clients to medical appointments and facilitating patient-provider discussions. Occupational health risks included harassment by police and drug dealers, needle sticks, and close proximity to drug use environments that could prompt drug relapse. Despite these challenges and risks, PEs are motivated by their personal experiences of overcoming addiction with help from harm reduction programs.
CONCLUSIONS/RECOMMENDATIONS: PEs play a vital role in HIV, HCV and harm reduction service delivery in Kenya, often exceeding their job descriptions by offering additional support to PWID. Recommendations include (1) advocating for PEs to provide patient navigation services, (2) promoting the use of post-exposure prophylaxis (PEP), (3) providing occupational mental health services to prevent drug relapse, and (4) collaborating with law enforcement to address harassment, with the ultimate goal of reducing HIV and HCV incidence among PWID.
在肯尼亚，减少伤害组织采用了基于证据的同伴教育者（PE）计划，以前的注射毒品者（PWID）作为社区卫生联络人，让 PWID 参与 HIV、HCV 和减少伤害服务。虽然 PE 在医疗保健服务中发挥着不可或缺的作用，但关于他们在与 PWID 合作时的角色、风险和经验的数据很少，这些数据可能被用于为当地减少伤害政策提供信息。
从内罗毕的两个减少伤害地点随机和有目的地选择 PE 参加半结构深入访谈。使用主题分析来描述 PE 在为 PWID 服务时预期和实际的角色、个人动机和/或挑战以及职业健康风险。使用 Atlas.ti 软件分析数据。
20 名 PE 参加了这项研究。平均而言，PE 的年龄为 37 岁，服务了 3 年。女性代表为 30%。预期的职责包括寻找客户、建立关系、教育和护送客户到成瘾护理设施。其他角色包括在工作时间之外照顾客户、护送客户就医和促进医患讨论。职业健康风险包括警察和毒贩的骚扰、针刺伤以及接近吸毒环境，这可能促使吸毒复发。尽管面临这些挑战和风险，但 PE 们受到自己从减少伤害计划中获得帮助克服毒瘾的个人经历的激励。
结论/建议：PE 在肯尼亚的 HIV、HCV 和减少伤害服务提供中发挥着至关重要的作用，经常通过为 PWID 提供额外的支持来超越他们的工作描述。建议包括：（1）倡导 PE 提供患者导航服务；（2）推广使用暴露后预防（PEP）；（3）提供职业心理健康服务以防止吸毒复发；（4）与执法部门合作解决骚扰问题，最终目标是减少 PWID 中的 HIV 和 HCV 发病率。
