Occupational roles and risks of community-embedded peer educators providing HIV, hepatitis C and harm reduction services to persons who inject drugs in Nairobi, Kenya.
Occupational roles and risks of community-embedded peer educators providing HIV, hepatitis C and harm reduction services to persons who inject drugs in Nairobi, Kenya.
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DOI：
10.1371/journal.pone.0278210
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发表时间：
2022
期刊：
影响因子：
3.7
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中科院分区：
文献类型：
--
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在肯尼亚，减少伤害组织采用了循证同伴教育者(PE)计划，在该计划中，前注射毒品者(PWID)担任社区健康联络人，让PWID参与艾滋病毒、丙型肝炎病毒和减少伤害服务。虽然PE在医疗保健提供中发挥着不可或缺的作用，但关于他们的角色、风险和与PWID合作的经验的数据很少，这些数据可能被用来为当地的减少伤害政策提供信息。来自内罗毕两个减少危害地点的PE被随机和有目的地挑选参加半结构化深度访谈。进行了专题分析，以确定PES在为PWID服务时所扮演的预期和实际角色、个人动机和/或挑战以及职业健康风险。使用Atlas.ti软件对数据进行分析。20名PE参与了这项研究。PES平均年龄37岁，工龄3年。女性占30%。预计的职责包括寻找客户，建立融洽的关系，教育和护送客户到成瘾护理机构。其他角色包括在工作时间以外照顾客户，护送客户去看医生，以及促进患者与提供者的讨论。职业健康风险包括警察和毒贩的骚扰、针头以及靠近可能导致毒品复发的吸毒环境。尽管有这些挑战和风险，PE的动机是他们在减少伤害计划的帮助下克服成瘾的个人经历。PES在肯尼亚提供艾滋病毒、丙型肝炎病毒和减少伤害服务方面发挥着至关重要的作用，经常通过为PWID提供额外的支持而超出他们的职责范围。建议包括(1)倡导PE提供患者导航服务，(2)推广接触后预防(PEP)的使用，(3)提供职业精神健康服务，防止药物复发，(4)与执法部门合作解决骚扰问题，最终目标是减少PWID中艾滋病毒和丙型肝炎的发病率。
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. 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.
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