Evaluating network-level predictors of behavior change among injection networks enrolled in the HPTN 037 randomized controlled trial.
Evaluating network-level predictors of behavior change among injection networks enrolled in the HPTN 037 randomized controlled trial.
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DOI：
10.1016/j.drugalcdep.2017.02.007
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发表时间：
2017-06-01
影响因子：
4.2
通讯作者：
Latkin C
中科院分区：
文献类型：
--
作者：
Smith LR;Strathdee SA;Metzger D;Latkin C
很少有人知道的方式网络层面的因素，可能会影响通过注射网络之间的组合预防行为，或如何以网络为导向的干预措施可能会缓和这种行为的变化过程。在宾夕法尼亚州费城，共有232个独特的注射风险网络被随机分配到一个同伴教育者网络导向的干预或护理标准控制臂。反映注射网络基线物质使用动态，社会互动，以及网络对性别和结构的暴露，计算相关的脆弱性，并用于预测6个月随访时采用更安全注射实践的网络成员比例的变化。在随访中，平均46.31%的网络成员观察到更安全的注射做法。相比之下，25.7%的网络没有观察到变化。控制干预效果后，影响网络层面行为变化的重要网络层面因素反映了更大规模的注射网络（B=2.20，p= 0.013），其中共享针头的成员比例更高（B=0.29，p<0.001）并参与基线时的多种药物使用（B=6.65，p= 0.021）。在新网络成员较少的网络中（B=-0.31，p=.008），以及在基线前6个月内成员比例较低的网络中（B=-0.20，p=.012）或更有可能接触药物治疗的网络中（B=0.17，p=.034），也观察到网络更安全注射做法的变化。一个显著的相互作用表明，干预措施独特地促进了女性网络中更安全注射做法的改变（B=-0.32，p= 0.046）。网络层面的因素提供了深入了解注射网络可能被利用，以促进组合预防工作的方式。
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=.013) with a greater proportion of members who shared needles (b=0.29, p<.001) and engaged in poly drug use at baseline (b=6.65, p=.021). Changes in a network’s safer injection practices were also observed for networks with fewer new network members (b=−0.31, p=.008), and for networks whose members were proportionally less likely to have experienced incarceration (b=−0.20, p=.012) or more likely to have been exposed to drug treatment (b=0.17, p=.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=.046). Network-level factors offer insights into ways injection networks might be leveraged to promote combination prevention efforts.