Adaptation and Implementation of Project Encuentro in the U.S.-Mexico Border
| Status: | Recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 18 - 75 |
| Updated: | 9/28/2017 |
| Start Date: | August 2016 |
| End Date: | April 2021 |
| Contact: | Julia Lechuga, PhD |
| Email: | jul416@lehigh.edu |
| Phone: | 6107584328 |
The proposed project is a research collaboration between the University of Texas at El Paso,
The Alliance for Border Collaboratives and Programa Companeros to adapt, implement, and
evaluate a multi-level community-based HIV prevention intervention (Project Encuentro). The
intervention will target active heroin and crack users and consists of increasing access to
HIV testing via a social network HIV testing component and reducing sexual and drug use risk
via a peer network brief behavioral Intervention. Encuentro also consists of conducting
community awareness meeting to target structural factors affecting HIV risk. The intervention
was developed in an area severely affected by violence and stigma towards drug users, El
Salvador, which makes it particularly suitable for adaptation to meet the needs of drug users
living in the proposed intervention site, the U.S.-Mexico border. The proposed intervention
site also has been severely affected by violence which has curtailed any prior attempts to
reduce the risk drug users' HIV risk. Violence has worsened structural factors which affect
HIV risk such as, increasing police persecution and stigma and reducing access to resources.
In our proposed project, we will engage in formative research to understand the context of
HIV risk of drug users in the border region post violence and adapt the intervention
accordingly. Findings will allow the investigators to tailor intervention components to meet
the needs of drug users in the region. Subsequently, the investigators propose to test
intervention effectiveness and evaluate implementation barriers and facilitators. To
accomplish project aims we will use a mixed qualitative, quantitative approach. The
investigators will begin with a formative phase by conducting in-depth interviews with drug
users (n = 40) living in the region to understand how the context of drug use risk changed as
a result of the violence and will administer a social network survey (n = 200) to
characterize the configuration of risk networks. Findings will yield the necessary
information to culturally adapt the intervention to meet the needs of drug users in the
region and will help the investigators focus recruitment efforts where the riskiest networks
are located. After the intervention is adapted with the help of the community advisory boards
and the community coalitions, the investigators will implement the intervention and will
assess the effectiveness and reach via 6 cross-sectional surveys administered to drug users
(n=1,200). The investigators will assess the process of implementation by conducting
ethnographic field notes of all intervention activities including community engagement and
Community Advisory Board and coalition meetings. The investigators will assess the fidelity
and quality of the intervention. Lastly, the investigators will conduct key informant
interviews with key stakeholders involved in the project and interviews and observations will
be coded to reflect key systems factors related to successful implementation of intervention
components in two intervention sites (El Paso, Texas and Ciudad Juarez, Mexico). Findings
will be highly significant as the investigators will be conducting parallel research on the
effectiveness of interventions shown to be effective in Latino drug users in two very
different contexts: El Salvador and the U.S-Mexico border. Findings will elucidate
implementation challenges and barriers and such information can then be used to assess the
effectiveness of diverse implementation strategies in organizations working to serve the
needs of Latino drug users.
The Alliance for Border Collaboratives and Programa Companeros to adapt, implement, and
evaluate a multi-level community-based HIV prevention intervention (Project Encuentro). The
intervention will target active heroin and crack users and consists of increasing access to
HIV testing via a social network HIV testing component and reducing sexual and drug use risk
via a peer network brief behavioral Intervention. Encuentro also consists of conducting
community awareness meeting to target structural factors affecting HIV risk. The intervention
was developed in an area severely affected by violence and stigma towards drug users, El
Salvador, which makes it particularly suitable for adaptation to meet the needs of drug users
living in the proposed intervention site, the U.S.-Mexico border. The proposed intervention
site also has been severely affected by violence which has curtailed any prior attempts to
reduce the risk drug users' HIV risk. Violence has worsened structural factors which affect
HIV risk such as, increasing police persecution and stigma and reducing access to resources.
In our proposed project, we will engage in formative research to understand the context of
HIV risk of drug users in the border region post violence and adapt the intervention
accordingly. Findings will allow the investigators to tailor intervention components to meet
the needs of drug users in the region. Subsequently, the investigators propose to test
intervention effectiveness and evaluate implementation barriers and facilitators. To
accomplish project aims we will use a mixed qualitative, quantitative approach. The
investigators will begin with a formative phase by conducting in-depth interviews with drug
users (n = 40) living in the region to understand how the context of drug use risk changed as
a result of the violence and will administer a social network survey (n = 200) to
characterize the configuration of risk networks. Findings will yield the necessary
information to culturally adapt the intervention to meet the needs of drug users in the
region and will help the investigators focus recruitment efforts where the riskiest networks
are located. After the intervention is adapted with the help of the community advisory boards
and the community coalitions, the investigators will implement the intervention and will
assess the effectiveness and reach via 6 cross-sectional surveys administered to drug users
(n=1,200). The investigators will assess the process of implementation by conducting
ethnographic field notes of all intervention activities including community engagement and
Community Advisory Board and coalition meetings. The investigators will assess the fidelity
and quality of the intervention. Lastly, the investigators will conduct key informant
interviews with key stakeholders involved in the project and interviews and observations will
be coded to reflect key systems factors related to successful implementation of intervention
components in two intervention sites (El Paso, Texas and Ciudad Juarez, Mexico). Findings
will be highly significant as the investigators will be conducting parallel research on the
effectiveness of interventions shown to be effective in Latino drug users in two very
different contexts: El Salvador and the U.S-Mexico border. Findings will elucidate
implementation challenges and barriers and such information can then be used to assess the
effectiveness of diverse implementation strategies in organizations working to serve the
needs of Latino drug users.
The intervention framework of the proposed Intervention is exerting change at multiple
levels, through community based approaches. At the structural level, the investigators
propose to increase the access to HIV testing of high risk drug users and to create change at
the community level regarding factors that influence the risk of drug users such as stigma
towards drug use and HIV among other topics. At the individual level, the investigators
propose to modify normative beliefs around risky behaviors in a social network and hence,
effecting change in participants by changing normative behavior around safer sexual
encounters, HIV testing, and reduced risk in injection and non-injection drug use. Following,
strategies to be employed in each intervention component are delineated.
Social Network HIV Testing Component. To prepare for the rolling-out of the social network
HIV testing component (during month 6 of year 2), the investigators will convene a two day
training with partner organizations from both sides of the border to train staff on the
social network referral methodology. Research staff will initiate the recruitment of seeds by
recruiting four to six seeds per city. Counselors, at the partner organizations, will begin
by administering a rapid HIV test and provide pre and post-test counseling to seeds.
Counselors, who will be trained in the social network assessment methodology, will then ask
seeds to list other drug users in their social network who they believe are at risk of
contracting HIV. Counselors will then provide participants with 3 coupons to recruit
identified network members for an HIV test. Referred participants who engage in high-risk
behavior will be also provided with 3 coupons to refer their own network members for an HIV
test. Whenever social network HIV testing rates slow, research staff will re-seed in the
communities to begin the recruitment process again. Counselors will make appointments for all
participants who test positive for confirmatory HIV testing at the respective local
governmental health care institutions. A research staff will follow-up with HIV positive
participants to engage them in care. Throughout the duration of the project, monthly meetings
will be convened between research staff involved in the project to ascertain that procedures
are being followed and retrain if the need arises. The social network component of the
intervention will continue until month 12 of year 5.
The Peer Network Intervention. During month 1 of year 4, we will roll-out the peer network
behavioral intervention. Two peer leaders will be selected from each city to deliver the
intervention sessions. Eligibility criteria will be being former drug users, having extensive
contacts, high degree of trust among peers, and motivation and demonstrated ability to work
fixed hours. During month 12 of year 3, training sessions, in collaboration with partner
organization, will be conducted to train peer leaders over the course of two weeks during ten
training sessions lasting 3 hours per session. Peer leaders will be trained in the curriculum
as well as in psychosocial theory as the basis for behavioral interventions, interactive
group management, HIV risk reduction, effective instruction for role-plays, and social
network recruitment methods. Peer leaders will recruit drug users they know who will be
asked, in turn, to recruit other drug users in their networks. If this initial contact is
unable to recruit network members, peer leaders will select other initial contact. Peer
leaders will deliver the intervention to 300 drug users (150 per border city) in cycles
composed of small social networks of 5-6 drug users. Four intervention cycles will be held
per month and will consist of 3 consecutive sessions of 2 hours in duration delivered in the
early afternoon. Peer leaders will be expected to comply with a fixed work schedule of 10
hours per week and will be asked to actively recruit social networks for each intervention
cycle. Although we expect the specific information and roles plays to change based on the
findings of our formative phase and our sessions of acceptability and feasibility with our
CAB and coalition, the peer network intervention will have the following structure. The first
session of the intervention will cover training in social contexts of risk and strategies to
avoid them through role plays, techniques for harm reduction for injection and non-injection
drug use, and available community resources to deal with substance abuse. The second session
will provide information about HIV and Sexually Transmitted Diseases through games, didactic
sessions, and exercises to rank the risk of contracting HIV from various behaviors,
negotiation skills for condom use in situations of high risk such as exchange of sex for
drugs. The third session will consist of training in advocacy and sexual rights and
establishment of a personal and social network risk reduction plan. Ethnographers will be
trained to document the process of delivery such as number of participants per intervention
cycle. Research staff will attend one intervention session per cycle to assess intervention
fidelity. Weekly meetings will be held with peer leaders and research staff to discuss
problems, solutions, and planning of community wide events.
Community-Wide Events. The community coalition in collaboration with the CAB and peer leaders
will be asked to plan and convene educational meetings at the community level with drug and
non-drug users to deliver information on topics such as drug use prevention and treatment,
HIV and risk reduction skills, and other issues affecting the HIV risk of communities such as
persecution of drug users by police, human rights violations, and sexual violence. They will
identify experts on topics identified and invite them as guest speakers.
levels, through community based approaches. At the structural level, the investigators
propose to increase the access to HIV testing of high risk drug users and to create change at
the community level regarding factors that influence the risk of drug users such as stigma
towards drug use and HIV among other topics. At the individual level, the investigators
propose to modify normative beliefs around risky behaviors in a social network and hence,
effecting change in participants by changing normative behavior around safer sexual
encounters, HIV testing, and reduced risk in injection and non-injection drug use. Following,
strategies to be employed in each intervention component are delineated.
Social Network HIV Testing Component. To prepare for the rolling-out of the social network
HIV testing component (during month 6 of year 2), the investigators will convene a two day
training with partner organizations from both sides of the border to train staff on the
social network referral methodology. Research staff will initiate the recruitment of seeds by
recruiting four to six seeds per city. Counselors, at the partner organizations, will begin
by administering a rapid HIV test and provide pre and post-test counseling to seeds.
Counselors, who will be trained in the social network assessment methodology, will then ask
seeds to list other drug users in their social network who they believe are at risk of
contracting HIV. Counselors will then provide participants with 3 coupons to recruit
identified network members for an HIV test. Referred participants who engage in high-risk
behavior will be also provided with 3 coupons to refer their own network members for an HIV
test. Whenever social network HIV testing rates slow, research staff will re-seed in the
communities to begin the recruitment process again. Counselors will make appointments for all
participants who test positive for confirmatory HIV testing at the respective local
governmental health care institutions. A research staff will follow-up with HIV positive
participants to engage them in care. Throughout the duration of the project, monthly meetings
will be convened between research staff involved in the project to ascertain that procedures
are being followed and retrain if the need arises. The social network component of the
intervention will continue until month 12 of year 5.
The Peer Network Intervention. During month 1 of year 4, we will roll-out the peer network
behavioral intervention. Two peer leaders will be selected from each city to deliver the
intervention sessions. Eligibility criteria will be being former drug users, having extensive
contacts, high degree of trust among peers, and motivation and demonstrated ability to work
fixed hours. During month 12 of year 3, training sessions, in collaboration with partner
organization, will be conducted to train peer leaders over the course of two weeks during ten
training sessions lasting 3 hours per session. Peer leaders will be trained in the curriculum
as well as in psychosocial theory as the basis for behavioral interventions, interactive
group management, HIV risk reduction, effective instruction for role-plays, and social
network recruitment methods. Peer leaders will recruit drug users they know who will be
asked, in turn, to recruit other drug users in their networks. If this initial contact is
unable to recruit network members, peer leaders will select other initial contact. Peer
leaders will deliver the intervention to 300 drug users (150 per border city) in cycles
composed of small social networks of 5-6 drug users. Four intervention cycles will be held
per month and will consist of 3 consecutive sessions of 2 hours in duration delivered in the
early afternoon. Peer leaders will be expected to comply with a fixed work schedule of 10
hours per week and will be asked to actively recruit social networks for each intervention
cycle. Although we expect the specific information and roles plays to change based on the
findings of our formative phase and our sessions of acceptability and feasibility with our
CAB and coalition, the peer network intervention will have the following structure. The first
session of the intervention will cover training in social contexts of risk and strategies to
avoid them through role plays, techniques for harm reduction for injection and non-injection
drug use, and available community resources to deal with substance abuse. The second session
will provide information about HIV and Sexually Transmitted Diseases through games, didactic
sessions, and exercises to rank the risk of contracting HIV from various behaviors,
negotiation skills for condom use in situations of high risk such as exchange of sex for
drugs. The third session will consist of training in advocacy and sexual rights and
establishment of a personal and social network risk reduction plan. Ethnographers will be
trained to document the process of delivery such as number of participants per intervention
cycle. Research staff will attend one intervention session per cycle to assess intervention
fidelity. Weekly meetings will be held with peer leaders and research staff to discuss
problems, solutions, and planning of community wide events.
Community-Wide Events. The community coalition in collaboration with the CAB and peer leaders
will be asked to plan and convene educational meetings at the community level with drug and
non-drug users to deliver information on topics such as drug use prevention and treatment,
HIV and risk reduction skills, and other issues affecting the HIV risk of communities such as
persecution of drug users by police, human rights violations, and sexual violence. They will
identify experts on topics identified and invite them as guest speakers.
Inclusion Criteria:
- at least 18 years old
- having engaged in sexual risk in the last 3 months
- able to give informed consent
- reported to have used crack or heroin in the last 30 days
Exclusion Criteria:
- under 18 years of age
- unable to give informed consent
- engages in disruptive behavior while participating in the project not using crack or
-heroin in the last month
- not reporting having engaged in sexual risk
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