Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Addiction. 2024 Mar;119(3):570-581. doi: 10.1111/add.16379. Epub 2023 Nov 15.
BACKGROUND AND AIMS: Network centrality, an indicator of an individual's importance and potential to drive behavioral change, is rarely used to select peer educators. Individual-level predictors of network centrality might be useful to identify people who inject drugs (PWID) for potential roles as peer navigators or change agents in network-based interventions in settings where sociometric data are unavailable. We assessed the relationship between network centrality and HIV prevention service engagement to determine whether centrally-positioned PWID share measurable commonalities. DESIGN: Observational study and survey using baseline data from a sociometric network cohort of PWID, enumerated using network software and biometric data (2017-2020). Network ties corresponded to direct injection partnerships in the prior month. SETTING: New Delhi, India. PARTICIPANTS: A total of 2512 PWID who were ≥18 years, provided written informed consent, and reported illicit injection drug use within the 24 months before study enrollment. MEASUREMENTS: Interviewer-administered questionnaires measured demographics and substance use behaviors. Central versus peripheral network position was categorized using betweenness centrality 75 . Logistic regression was used to estimate adjusted odds ratios (aOR) with 95% confidence intervals (95%CI) between network position and HIV testing, medication for opioid use disorder (MOUD), or syringe service use. Lasso models selected predictors of central network position among 20 covariates detailing demographic, biologic, and substance use information. Predictive accuracy was evaluated using model performance metrics. FINDINGS: Overall, median age was 26 years (interquartile range 22-34); 99% were male; 628 were classified as central. Compared with PWID at the periphery, central PWID were more likely to use MOUD (aOR: 1.59, 95%CI: 1.30-1.94) and syringe services (aOR: 2.91, 95%CI: 2.25, 3.76) in the prior six months. Findings for HIV testing were inconclusive (aOR: 1.30, 95%CI: 1.00-1.69). The lasso variable selector identified several predictors of network centrality: HIV and hepatitis C infection, number of PWID seen in the prior month, injecting heroin and buprenorphine (vs. heroin only) six months prior, sharing injection equipment six months prior, experiencing drug overdose in the past year, and moderate/severe depression (vs. none/mild). Average agreement between model-predicted vs. observed values was 0.75; area under the receiver operator curve was 0.69. CONCLUSIONS: In a socioeconomic network of people who inject drugs (PWID) in New Delhi, India, there are common characteristics among individuals based on their network position (central vs. peripheral) but individual-level predictors have only moderate predictive accuracy. Although central network members appear to be more likely to use HIV prevention services than peripheral network members, their potential as change agents may be limited by other factors that impede their ability to adopt or promote HIV prevention service use.
背景与目的:网络中心性是衡量个体推动行为改变的重要性和潜力的指标,很少用于选择同伴教育者。个体网络中心性的预测因素可能有助于在无法获得社会计量数据的情况下,识别出可能作为同伴导航员或网络干预改变代理人的吸毒者(PWID)。我们评估了网络中心性与 HIV 预防服务参与之间的关系,以确定处于中心位置的 PWID 是否具有可衡量的共同特征。 设计:对使用网络软件和生物计量数据(2017-2020 年)对 PWID 进行社会计量网络队列的基线数据进行观察性研究和调查。网络联系对应于前一个月的直接注射伙伴关系。 地点:印度新德里。 参与者:共有 2512 名年龄≥18 岁、书面知情同意、并在研究入组前 24 个月内报告过非法注射药物使用的 PWID。 测量方法:访谈者管理的问卷测量了人口统计学和物质使用行为。使用中介中心度 75 将网络位置分为中心与外围。使用逻辑回归估计网络位置与 HIV 检测、阿片类药物使用障碍的药物治疗(MOUD)或注射器服务使用之间的调整后比值比(aOR),95%置信区间(95%CI)。套索模型从详细描述人口统计学、生物学和物质使用信息的 20 个协变量中选择中心网络位置的预测因素。使用模型性能指标评估预测准确性。 结果:总体而言,中位年龄为 26 岁(四分位距 22-34 岁);99%为男性;628 人被归类为中心。与外围的 PWID 相比,处于中心位置的 PWID 在过去六个月中更有可能使用 MOUD(aOR:1.59,95%CI:1.30-1.94)和注射器服务(aOR:2.91,95%CI:2.25,3.76)。HIV 检测结果尚无定论(aOR:1.30,95%CI:1.00-1.69)。套索变量选择器确定了几个网络中心性的预测因素:HIV 和丙型肝炎感染、前一个月看到的 PWID 数量、前六个月注射海洛因和丁丙诺啡(而非海洛因)、前六个月共用注射设备、过去一年药物过量和中度/重度抑郁(而非无/轻度)。模型预测值与观察值之间的平均一致性为 0.75;接受者操作特征曲线下面积为 0.69。 结论:在印度新德里的一个吸毒者(PWID)社会网络中,基于其网络位置(中心与外围)存在个体之间的共同特征,但个体水平的预测因素只有中等的预测准确性。尽管中心网络成员似乎比外围网络成员更有可能使用 HIV 预防服务,但他们作为改变代理人的潜力可能受到其他阻碍他们采用或推广 HIV 预防服务使用能力的因素的限制。
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