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Table 1 Study description

From: Peer education for HIV prevention among high-risk groups: a systematic review and meta-analysis

StudyCountry & GroupsStudy designIntervention descriptionComparisonFollow-uptime
M. A. Davey-Rothwell 2011the US, FSWsRCTThe social network based intervention defined a Peer Mentor as someone who had meaningful conversations with partners, friends, and other people in their social networks. It consisted of five small group sessions and one individual session. Each group session included facilitated discussions, presentation of new information, and Peer Mentoring practice activities like role-plays.One group session delivered by a female facilitator. The session, lasting about 90 minutes, focused on HIV and sexually-transmitted infections (STIs) transmission and risk reduction information and consisted of didactic presentations and a culminating game.6,12,18 months
Hilary L. Surratt 2014the US, FSWsRCTA strengths-Based / Professional-Peer (PP) Condition. The peer facilitator participated in the intervention sessions and remained in contact with their cases throughout the entire six months study participation period, providing ongoing support for service linkage.A strengths-based / professional-only (PO) condition, in which a professional case manager partnered with the participant.3,6 months
Scott D. Rhodes 2011the US, heterosexua lly active peopleRCTThe HIV intervention was peer-led; three people from rural areas were recruited and trained to serve as peer educators. They were trained in four sessions including the epidemiology of HIV and health disparities, HIV transmission, risk behavior, cultural and social influences on sexual health, access to health-care services, predictors of behavior change, and group facilitation.The cancer education comparison intervention was delivered in one 2-hour session and focused on prevention of cancers particularly relevant to men: prostate, lung, and colorectal cancers.3,12 months
Theresa H Hoke 2007Madagascar, sex workersRCTPeer educators trained by the study provided all participants risk reduction counselling that included condom promotion. Peer educators were in frequent contact with supervising clinic personnel. The study manager also met monthly with peer educators to monitor and encourage mastery of counselling and other duties.Peer& clinic arm received bi-monthly clinic counselling sessions, delivered by a nurse and a physician and led by a consultant specializing in behaviour change contact and lasting about 15 minutes.12 months
Ishika Basu 2004India, sex workersquasi-R CTIntervention: Standardizing resources and the enhanced intervention groups included training by a team of local peer educators. Goals were to build skills and confidence in providing education and foster empowerment for local sexual workers.Only standardizing resources, including health clinics and health care services6,12,16 months
Alfonso Ang 2012Philippines,FSWsRCTThe first group was the peer education intervention group which received a special intervention consisting of peer leader training, role playing for development of skills, etc. The second group consisted of managers of the officers. The third intervention group received both peer education and managerial training intervention.The control group received usual educational materials and presentations by the social hygiene clinic nurses.12 months
Vivian F.Go 2013Vietnam, IDUsRCTThe experimental intervention consisted of six 2-h, small group, peer educator training sessions during a six-week period and three booster sessions. The intervention is modeled on Self-Help in Eliminating Life-threatening Diseases, a peer network-oriented intervention that successfully reduced injecting and sexual behaviors.Control: standard of care and government sponsored pamphlets on HIV.3,6,12 months
Dianmin Kang 2013China, FSWsPost-intervention cross-sectionalsurveyThe integrated individual level intervention, community mobilization and structural interventions included 100% condom promotion activities, outreach and peer education to promote risk and health-seeking behavior change, to expand HIV testing and promote standardization of clinical STI services, monitoring and encouraging adherence.Control: the standard of care, the routine testing, prevention, but not the integrated individual, community, and structural intervention.5 years
Xiushi Yang 2011China, FSWsA cluster RCTThe intervention condition consisted of small group, peer-assisted multiple sessions that aimed to improve HIV knowledge, enhance personal motivation to take preventive actions, develop preventive behavioral skills. The interventions were five 60–90-minute multimedia group sessions, which were broken down to multiple mini sessions of 45–50 minutes each and delivered, once a week, on-site in the establishment.The control condition was a group-based didactic education. The informational education was divided into the same number of mini sessions which were conducted by trained health educators.3 months
Carl Latkin 2009Thailand,IDUsRCTSix two-hour, small-group, network-oriented peer educator training sessions during a four week period and two booster sessions at six and 12 months. The sessions included instruction in methods of harm reduction, developing and practicing communication skills and strategies, role-plays, and problem solving exercises. At each session, participants developed a plan about how they would discuss and encourage injection and sexual risk reduction with the specific network members.Control: no intervention beyond volunteer counselling testing was received6 months
D.W.Purcell 2007the US, IDUsRCTA 10-session peer mentoring interventionAn 8-session video discussion intervention.3,6,12 months
M.Yun Gao 2007China, MSMA quasi-experimentGave the intervention program with conducting peer-led participatory activities, and tested again. The stories in the series represented key issues on the exposure to epidemics in the gay community and strategically promoted awareness of STIs and HIV prevention. Three small media materials provided further support for relevant educational messages. Based on gay men interests, outdoor edutainment activities were organized to expand their networks and get them to make friends.Received no intervention information, and were tested again .6 months
Nai-Ying Ko 2013China, Taiwan, MSMA quasi-experimentThe 369 internet Popular Opinion Leaders (iPOLs) were trained by HIV/STI experts during a 12-week period. The iPOLs platform used 2-way communication format on Facebook in which the iPOLs shared and exchanged news, video clips, reports, and opinions, and had the capability to connect with others for advice and support. Intervention: 2-way conversations related to risky behaviors on the online iPOLs platform were reviewed by iPOLs, discussed, and reinforced at subsequent iPOLs training sessions.Control: no intervention6 months
Sean D. Young 2013the US, MSMA cluster RCTIntervention: sixteen peer leaders were randomly assigned to deliver information about HIV or general health to participants via Facebook groups over 12 weeks. Peers delivered information on HIV prevention.Peer delivered information on general health over Facebook.12 weeks
Sean D. Young 2015Peru, MSMA cluster RCTIntervention: peer leaders would attempt to interact with participants about the importance of HIV prevention and testing.Enhanced standard of care provided by local community clinics and government.12 weeks
Hongjing Yan 2014China, MSMCohort studyAn MSM peer-led, community-based organization (CBO), mobile rapid HIV testing program. MSM peers were trained and certified in HIV counselling for pretest and post-test sessions. After discussing the means of acquiring and preventing HIV infection and the clients’ behaviour, individualized risk reduction counselling was done. Following pretest counselling, a finger-prick rapid HIV test was performed by the peer in the private room or van and screening test results were disclosed with post-test counselling.Comparison: surveillance surveys6 months
Marco A. Hidalgo 2015the US, MSMRCTIntervention: Male Youth Pursuing Empowerment, Education and Prevention around Sexuality (MyPEEPS) is a group-level intervention consisting of 6 modular, interactive, group sessions (2 h each) and delivering twice weekly for 3 weeks. Two gay / bisexual male facilitators, both of whom had extensive experience leading group-based interventions among lesbian, gay, bisexual, and transgender (LGBT) youth.A group level intervention focused on HIV risk reduction but relied entirely on a lecture format led by facilitator.6,12 weeks
Joseph T.F Lau 2013HongKong, China, MSMA cluster RCTIntervention: The seed peer educator (SPE) delivered manual-based and theory-based peer education to their fellow social network members (SNM) during the 2-month study period. The trained SPE delivered the theme-based HIV prevention messages to their SNM via daily social contacts, using the standard scripts as references. Samples of phone text messages and emails were provided to the SPE but flexibility was allowed. Repetitions in different wordings and settings were encouraged.Control: SPE gave some printed education materials to their fellow SNM.6 months
Guodong Mi 2015China, Chengdu, MSMA quasi-RCTFour complementary modules: an information exchange website, a bulletin board program, individualized one-on-one online counseling, and an animated game. The individualized one-on-one online counseling was conducted by eight peer educators through Tencent QQ every evening during the study period. Peer educators summarized and posted answers to frequently asked questions on the information exchange website.Control: followed standard-of care procedures and did not receive an intervention.6 months
Carl Latkin 2013the US, IDUsRCTSix 2-hour peer-educator sessions and two booster sessions. The training focused on teaching indexes 1) how to promote safer sex and drug injection skills among network members, and 2) promote norms about HIV risk reduction with their members. Participants engaged in role-plays to practice their risk reduction skills. Participants were encouraged to model safer behaviors when they were with their peers. A major component of the training focused on developing communication skills on how to talk with network members about risk reduction.Participants randomized into the control condition did not participate in any intervention sessions.24 months
Richard S. Garfein 2007the US, IDUsRCTThe intervention consisted of six 2-h sessions. Session 1 described HIV and HCV transmission through sex and injection drug use, informed participants about disease prevalence in their communities, and described the vital role peer educators play in preventing further disease spread. Sessions 2 and 3 provided peer education about safer injection and sexual practices. Session 4 added skills-building activities. During session 5, small teams of up to five participants conducted 90-min peer education sessions. Session 6 consisted of a large group debriefing, goal-setting to encourage continued risk reduction.A video discussion intervention (VDI). Participants watched hour-long films addressing social and health issues followed by facilitated discussion using scripted questions.6 months
Irving F. Hoffman 2013Russia, IDUsRCTIndexes attended eight training sessions aimed at understanding the risks associated with injecting drug use and unprotected sex, and development of safe behavior skills. After completing the training, index participants from the experimental group were invited to repeat (booster) meetings once a month for 4 months to discuss their strategies, successes and failures in implementing information transfer to their network members.Eight sessions of equivalent length devoted to discussing issues of interest, viewing lifestyle videos, practicing non-specific exercises. No booster sessions were offered.2 years
Karin Elizabeth Tobin 2011the US, IDUsRCTThe STEP into Action intervention sought to train active injection drug users to be Health Educators and focus to individuals in their personal social network who inject and/or are sexual partners. The intervention condition focused on promoting risk reduction with personal risk network and consisted of 5 group-based, one individual and one session with the Index participant. Content of the group sessions focused on increasing skills to reduce injection communication skills to conduct outreach to personal risk networks.5 group-based sessions that addressed injection drug-use related topics. The sessions were informational and did not include skills training.6,12,18 months
Aleksandra Mihailovic 2015the US, IDUsRCTThe intervention consisted of information about HIV prevention and teaching participants the skills needed to promote risk reduction within their personal risk networks. It had seven sessions, five of which were group-based. The topics were: introduction to the health educator role and communication, reduction of injection and drug splitting risk behavior, etc. All sessions were imparted by peer educators.Five-group sessions during which participants received information on injection-drug use topics, but were not taught skills for HIV risk reduction.6,12,18 months
Mary E. Mackesy-Amiti 2012the US, IDUsRCTIn the first sessions, participants learned what it meant to be a peer educator. The first two sessions focused on injection-related risk and the third and fourth sessions focused on sexual risk behavior. In the fifth session, participants were given an opportunity to practice sharing risk-reduction information in a community setting. The sixth session consisted of a group debriefing about the community-based peer education session.Watching videos followed by facilitated discussion for an equivalent amount of time as the intervention group. Videos addressing social and health issues were chosen to be of interest to the target population.6 months
Robert E. Booth 2016Ukraine, IDUsRCTIntervention training consisted of five sessions delivered in small groups over a 2 week period designed to motivate peer leaders to become educators within their injection network and provide them with skills training in how to teach HIV risk reduction behaviors to network members effectively. Peer leaders were encouraged to model safe behaviors with their network members. Training sessions consisted of role playing and other interactive learning techniques.The testing and counselling intervention, Ukraine’s standard of care.12 months
Carl A Latkin 2003the US, IDUsRCT10-sessions program and each session last 90 min. The training program incorporated cognitive-behavioral intervention components. Everybody study focused on drug risk reduction among risk networks. Role-playing and other safer sex exercises were included to increase participants’ comfort level in discussing and using condoms. Participants reviewed skills and made a public commitment to continue the learning process and peer education.The initial session contained basic HIV prevention education. Each of the other control sessions consisted of a 1-hr videotaped presentation and 30-min group discussion.6 months
Song-Ying Shen 2011China, IDUsPilot interventionThe peer-based behavioral intervention was organized by physician, nurse, and coordinator. The intervention program included: recruitment, training peer educators, and implementation: (1) delivering one-on-one training to peers; (2) engaging in exercises focusing on injection and sexual risk behaviors; (3) activities designed to get participants to practice new skills.Control: routine HIV/STI education consisted of police personnel handing out educational pamphlets and providing lectures focused on HIV/STI education3 months
Robert E. Booth 2011Ukraine, IDUsQuasi-RCTThe intervention consisted of 5 sessions led by outreach workers, delivered in small groups over 2 weeks, designed to empower peer educators to be mentors and provide them with training in how to effectively motivate their network members to reduce HIV risk behaviors. Network members typically accompanied their peer educator to the NGOs in groups. Each highly scripted session included role playing and other interactive learning techniques and exercises.Individually-based: Injection drug users were asked where they saw them selves on each hierarchy and, together with outreach workers, asked to discuss what they could do to move to lower-risk positions.2 years
Susan G. Sherman 2009Thailand, IDUsRCTThe peer education condition aimed to teach participants to think critically about and reduce their methamphetamine use and sexual risk behaviors. Participants were taught communication skills that they practiced in role plays during the sessions and risk reduction messages to specific social network members that were identified through a social network inventory administered at baseline.The sessions focused on the causes and consequences of methamphetamine use. The sessions placed no emphasis on discussing the session content with social network members.3,6,9,12 months
Yu Liu 2018China, MSMOne-on one RCTParticipants would receive a message sent by the designated peer counsellor social media apps to schedule a mutually confirmed time within the buffering period. The peer-counselling session involved a one-on-one 60-minute discussion focusing on topics regarding specific high-risk behaviors modification, including the strategy to reduce male/female sexual partners, condomless anal/oral sex, commercial sex. At the end of the counselling, peer counsellor and participant would identify one or more goals for safer sex to be qualitatively evaluated in the next visit.Standard of care (SOC) participants received counselling provided by a CDC trained doctor. A generic message reminder was sent to the participants 3 days prior to the scheduled visit. The 30-min SOC counselling covered contents related to safer sex and prevention of HIV transmission per China CDC’s HIV counselling guidelines.3 months
Yuwen Duan 2013China, MSMQuasi-RCTA 12-month community level intervention involving MSM popular opinion leaders (POLs) to advocate for safer sexual behaviors to MSM community members and distribute HIV-education materials and condoms in targeted MSM-themed venues. Influential and respected peer leaders were used.Standard HIV prevention activities in accordance with national and municipal policy including availability of HIV related health education materials and voluntary HIV counseling and testing services at health clinics.12 months
R.S.Broadhead 2006Russia, IDUsA quasi-experimentIn the Standard-PDI, IDU-recruiters are offered nominal monetary rewards for both recruiting peers and educating them in a body of prevention information. (PDI: peer education intervention)In the Simplified-PDI, IDU-recruiters are asked to educate and recruit their peers, but the reward for recruiting is woven into their education efforts. This modification made it 50% less expensive to operate in respondent fees.6 months
StudyCountry & groupsStudy designIntervention descriptionFollow-up time
S Thilakavachi 2011India, FSWsA serial cross-sectionalstudy Avahan program, the India AIDS Initiative, a large-scale HIV prevention program, including: (1) peer-mediated outreach to identify and address difficulties reported by FSW, plus behavior change communication to promote condom use and regular STI screening; (2) establishment of dedicated sexual health services for FSW and their regular partners, offering STI identification and syndrome case management, etc.3 years
B. Ramesh2010
Hari Kumar.2011
Mandar M. 2011
India, FSWsA serial cross-sectional studyThe Avahan program mentioned above.3 years
P. Goswami 2012
T.Subramanian 2013
India, MSMA serial cross-sectionalstudy The Avahan program mentioned above.4 years
Shajy Isac 2015India, FSWsA serial cross-sectionalstudy The main interventions included peer-led community outreach and community mobilization. Three main strategies were employed to address HIV prevention among FSWs and their clients: promotion of safer sex behavior through a peer-mediated communications strategy; and enhancement of the enabling environment for the adoption of safer sex practices.8 years
Hongbo Zhang 2010China, MSMCohort studyA peer-driven behavioral intervention was chosen to influence the MSM peer networks. Each intervention group consists of a seed and his referral chain made up of his peers, consisting of 4 1.5-hour sessions with activities such as role playing, games, group discussions, brain storming, and competitions to test knowledge.3 months
Isidore T Traore 2015Burkina, FSWsA prospective, intervention cohort studyThe intervention combined prevention and care within the same setting, consisting of peer-led education sessions, psychological support etc. Peer-led education sessions were conducted every day at the study clinic and weekly in the sex work venues, addressing seven themes including HIV testing, STI diagnosis and treatment, genital herpes, condom use.2 years
Stanley Luchters 2008Kenya, FSWsPre and post intervention cross-sectional surveysPeer educators conducted one-on-one or weekly-group sessions. Peer-led activities occurred throughout the five-year period at a relatively constant rate. Peer educators also led monthly community gatherings with active participation of FSW, youth and other community members. They provided HIV education, condom promotion and other risk reduction activities and were accompanied by mobile volunteer-based testing services, facilitating entry to HIV testing.5 years
Xue haoming 2015Vietnem, FSWsSerial cross-sectional studyPeer advise, training, lectures, interactive games, free condom distribution were provided5 years
Simran Shaikh 2016China, FSWsa pre- and post-intervention cross-sectional survey designInterventions included behavior change communication such as outreach-based interpersonal communication through peers, media posters and so on. These communications provide counselling and information on safe sex, STIs, condom use, HIV testing. The program provides three broad categories of activities. The first focuses on improving the organizational and technical capacity of community-based organizations (CBOs) working with transgender communities. The second is to support CBOs to provide a range of basic community-based prevention and linkage to care interventions.4 years
Zhu Junli 2008China, Anhui, MSMcohort studyIntervention based on the combination of initiator-led and peer-driven effects. Stage 1: risk assessment; stage 2: develop safety behavior plan; stage 3: behavior change practice; stage 4: behavior change enhancement3 months
Duangta Oawa 2013Thailand, FSWsA quasi-experimental studyPopulation Services International (PSI) has implemented the Sisters program to prevent HIV among transgender women in the city of Pattaya. Sisters offers a drop-in center (DiC) that provides counseling, and on-site HIV and STI testing. Sisters also engages in peer-led interpersonal communication. Peer educators meet clients in a safe, private location for counseling, psycho-social/emotional support, and information on gender reassignment, and cosmetic surgery. Peer educators facilitate linkages to transgender-friendly government health services and will accompany.12 months
Issouf Konate 2011Burkina Faso, FSWsCohort studySix peer leaders, supervised by a coordinator, were trained to lead group education sessions. Each peer leader supervised 5 field workers peers who carried out more individually tailored information, education and communication sessions at working sites day and night, identified potential participants, and maintained adherence to follow-up visits.12 months
Scott Geibel 2012Kenya, sex workersTwo independent cross-sectional surveys40 peer educators were recruited and trained in HIV prevention. All the peer educators were given additional training in basic counselling skills. The peer educators also attended workshops on alcohol and drug harm reduction related to HIV prevention. Approximately 1900 male sex workers and non-sex worker MSM contacts were recorded by the peer educators. Activities during these contact sessions included brief counselling, health referrals and/or condom/lubricant distribution.12 months
Yuri A. Amirkhanian 2005Russia, Bulgaria, MSMA randomized social network HIV prevention trialExperimental condition social network leader attended a group training program with five to nine leaders of other networks. The aim was to establish regular HIV prevention communication between the leaders and their network members. Trainers used behavioral techniques to help network leaders gain skill and comfort in delivering HIV prevention messages. Control: no intervention.3 months
AL Wietz 2015Malawi, MSMCohort studyIntervention: individual, health-care, and community levels. The individual-level component included outreach and education provided by 10 trained peer educators and aimed to reduce behavioral risks for HIV and improve use of HIV prevention methods. The health sector intervention focused on providing an intensive training with pre- and post-test evaluation of 25 staff. The community-level intervention focused on capacity building through the empowerment of peer educators with an aim to increase community permeation of HIV prevention packages.10,13,16 months
Lisa M Williamson 2001British, MSMCohort studyThe Gay Men’s Task Force (GMTF) initiative trained 42 peer educators to work in bars contacting homosexual men. The peer educators wore distinctive uniforms and would distribute GMTF leaflets on sexual health and behavioral issues and then approach men to discuss both these and wider issues along with advocating sexual health service uptake. A contact involved a conversation between a peer educator and a customer in the bar, where issues raised by both would be discussed and further leaflets distributed if required. The resultant discussions covered a wide range of health-related topics and while these did mainly reflect the content of the leaflets, other issues related to sexually transmitted infections and condoms and lubricants were also raised.9 months
Don C. Des Jarlais 2007Vietnam China, IDUsSerial cross-sectional surveysThe intervention follows a peer outreach model developed in the United States. The peer educators regularly contact other IDU in the community and provide them with information on reducing drug use and sexual risk behaviors. They distribute sterile needles and syringes, sterile water for injection, condoms, and no-cost vouchers that can be redeemed for sterile injection equipment and condoms in participating local pharmacies. The peer educators also collect and safely dispose of used needles/syringes directly from drug injectors at injecting sites in the community.6,12,18,24 months
Sylvia Abebajo 2015Nigeria, IDUs, MSMSerial cross-sectional analysisA standard mobile outreach service, was designed to provide HCT services through a network of mobile community-based key opinion leaders (KOLs). KOLs were male most-at-risk-populations (M-MARPs) community influencers and mobilizers who were trained as peer educators to deliver the minimum prevention package intervention (MPPI) to community members.3 years
Bindya Jain 2014India, IDUsCohort studyEach peer educator is required to meet five to six IDUs a day during one-to-one or group education sessions. While one-to-one sessions generally last for 15-30 min, group sessions are longer (30–45 min), depending on the topics covered and the type of services provided during the session. Peer educators primarily counsel IDUs on behavior change including safe needle-syringe use and safe sex for the prevention of HIV and other sexually transmitted infections (STI).2 years
Theodore M.Hammett 2005China, Northern Vietnam, IDUsSerial cross-sectional studyThe peer educators, who receive initial and refresher training, provide IDUs with HIV risk reduction information and distribute new needles/syringes and condoms and vouchers redeemable in participating pharmacies for new needles/syringes and condoms. The peer educators also collect and dispose of used needles/syringes.18 months
Theodore M.Hammett 2012China,Vietnam, IDUsSerial cross-sectional studyThe peer educators regularly contact other IDUs in the community and provide them with information on reducing drug use- and sex-related HIV risks, verbally and through distribution of brochures. They distribute new needles/syringes, ampoule of sterile water for injection solution, and condoms and vouchers redeemable for these items at participating pharmacies. The peer educators also perform a valuable public health service by collecting and disposing of used needles/syringes that might otherwise put community residents at risk. In addition, the peer educators' weekly meetings include training on special topics. The peer educators are supervised locally by health department staffs.6, 12, 24, 48, 72, 84 months
Theodore M.Hammett 2011Vietnam, IDUsSerial cross-sectional studyThe project employs a peer district coordinator and 4–5 other peer educators (PE) in each district. Each PE has an active caseload of approximately 50 sexual partners (SPs). The PEs assess the needs and situations of each SP and provide risk reduction information, materials, commodities, and referrals tailored to each client. PEs also promote other HIV prevention approaches including lower-risk sexual activity and ARV treatment for the male partner where indicated, with high adherence. Regular HIV testing is also promoted through referrals to fixed site and mobile VCT.12, 24 months
Katherine P. Theall 2015the US, IDUsTwo rounds cross-sectional studiesThe study design consisted of two phases. During Phase 1, ethnographic research was conducted and to obtain baseline data on target community members. Phase 2 of the study consisted of the implementation and evaluation of the community-based popular opinion leaders (c-POL) intervention. POL training consisted of two 90-minute group sessions, one week apart, led by both staff depending on the C-POLs-female field staff for female POLs and male field staff for male POLs. In session one the leaders reviewed basic epidemiology of HIV infection, high-risk behaviors and risk reduction techniques, and began training to provide effective health promotion and prevention messages. Session two continued training as well as social skill rehearsals or role-play of techniques learned.6 months
Margaret R.Weeks 2009the US, IDUsCohort studyProject risk avoidance partnership (RAP) implemented a two-level intervention program. At the first (staff delivered) level, peer health advocates (PHAs) received the RAP Peer Health Advocacy Training Curriculum which was a 10-session, theoretically driven interactive training program. The second-level of RAP intervention was the modular program PHAs delivered to their peers, called the RAP Peer-delivered Intervention. This required PHAs to engage recipients during each interactive encounter in at least two of three primary intervention components: 1) provision of prevention education, 2) demonstration of proper prevention practices, and/or 3) delivery of prevention materials.6 months