Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Int AIDS Soc. 2024 Apr;27(4):e26241. doi: 10.1002/jia2.26241.
INTRODUCTION: Injection drug networks may influence their network members' health-seeking behaviours. Using data from a sociometric injecting partner network of people who inject drugs (PWID) in New Delhi, India, we assessed the role of injecting partner (alter) behaviours on individual engagement in HIV prevention services. METHODS: We enumerated injecting partner linkages among 2512 PWID using coupon referrals and biometric data from November 2017 to March 2020. Participants completed interviewer-administered questionnaires and provided information on injection behaviours, injecting partners, HIV/hepatitis C (HCV) testing and service engagement. Multilevel multiple-membership models (MMMM) evaluated individual PWID HIV testing, medication for opioid use disorder (MOUD) and syringe service engagement as a function of alter attributes, accounting for membership across multiple ego-networks. Logistic regression models assessed parallel associations among socially proximal injecting peers, defined as PWID ≤3 path length from ego. RESULTS: Median age was 26 years; 99% were male. PWID had median 2 injecting partners and 8 socially proximal peers; 14% reported HIV testing, 33% accessed MOUD and 13% used syringe services 6 months prior. In MMMM analyses, PWID with ≥1 versus 0 injecting partners who received HIV testing were significantly more likely to report HIV testing (adjusted odds ratio [aOR]: 2.27, 95% confidence interval [CI]: 1.68-3.16), MOUD (aOR: 1.99, 95% CI: 1.60-2.53) and syringe service use (aOR: 1.66, 95% CI: 1.21-2.39). We observed similar findings for individual MOUD and syringe service use. Having ≥1 versus 0 HIV-positive partners was associated with decreased HIV testing and MOUD but increased syringe service use (aOR: 1.54, 95% CI: 1.09-2.17). PWID with ≥1 versus 0 socially proximal peers who used non-sterile injection equipment reported increased HIV testing (aOR: 1.39, 95% CI: 1.01-1.92), MOUD (aOR: 1.40, 95% CI: 1.10-1.77) and syringe service use (aOR: 1.82, 95% CI: 1.23-2.68). CONCLUSIONS: We found differential associative relationships between individual HIV prevention service engagement and the health or risk behaviours of direct and indirect alters. Characterizing network exposure beyond direct injecting partnerships provided important context on possible mechanisms of behavioural influence. Findings could be leveraged to design peer-based interventions that promote network diffusion of health-seeking behaviours.
简介：注射毒品网络可能会影响其网络成员的寻医行为。本研究使用来自印度新德里注射吸毒者（PWID）社会计量注射伙伴网络的数据，评估了注射伙伴（改变者）行为对个体参与艾滋病毒预防服务的影响。
方法：我们使用优惠券推荐和 2017 年 11 月至 2020 年 3 月的生物识别数据，对 2512 名 PWID 的注射伙伴联系进行了计数。参与者完成了访谈员管理的问卷调查，并提供了关于注射行为、注射伙伴、艾滋病毒/丙型肝炎（HCV）检测和服务参与的信息。多水平多重成员模型（MMMM）评估了个体 PWID 的艾滋病毒检测、阿片类药物使用障碍（MOUD）药物治疗和作为改变者属性的注射器服务参与情况，考虑了多个自我网络中的成员资格。逻辑回归模型评估了社会上相近的注射同伴之间的平行关联，这些同伴被定义为与自我距离≤3 个路径长度的 PWID。
结果：中位年龄为 26 岁；99%为男性。PWID 的中位注射伙伴数为 2 人，社会上相近的同伴数为 8 人；14%报告了艾滋病毒检测，33%获得了 MOUD，13%在 6 个月前使用了注射器服务。在 MMMM 分析中，与 0 名相比，有≥1 名注射伙伴且接受了 HIV 检测的 PWID 报告 HIV 检测（调整后的优势比[OR]：2.27，95%置信区间[CI]：1.68-3.16）、MOUD（OR：1.99，95%CI：1.60-2.53）和注射器服务使用（OR：1.66，95%CI：1.21-2.39）的可能性更高。我们观察到个体 MOUD 和注射器服务使用的类似发现。与有≥1 名相比，有 0 名 HIV 阳性伙伴与 HIV 检测和 MOUD 的减少有关，但与注射器服务的使用增加有关（OR：1.54，95%CI：1.09-2.17）。与有≥1 名相比，有 0 名社会上相近的同伴使用非无菌注射设备的 PWID 报告 HIV 检测（OR：1.39，95%CI：1.01-1.92）、MOUD（OR：1.40，95%CI：1.10-1.77）和注射器服务使用（OR：1.82，95%CI：1.23-2.68）的可能性更高。
结论：我们发现，个体艾滋病毒预防服务参与情况与直接和间接改变者的健康或风险行为之间存在差异关联。对直接注射伙伴关系之外的网络暴露进行特征描述，为行为影响的可能机制提供了重要的背景信息。研究结果可以被利用来设计基于同伴的干预措施，促进网络中健康寻求行为的传播。
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