Peer driven or driven peers? A rapid review of peer involvement of people who use drugs in HIV and harm reduction services in lowand middle-income countries

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Authors

Chang, Judy
Shelly, Shaun
Busz, Machteld
Stoicescu, Claudia
Iryawan, Arif Rachman
Madybaeva, Dinara
De Boer, Yuri
Guise, Andy

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BioMed Central

Abstract

INTRODUCTION: Peer involvement of people who use drugs within HIV and harm reduction services is widely promoted yet under-utilised. Alongside political and fnancial barriers is a limited understanding of the roles, impacts, contexts and mechanisms for peer involvement, particularly in low- and middle-income settings. We conducted a rapid review of available literature on this topic. METHODS: Within a community-academic partnership, we used a rapid review approach, framed by realist theory. We used a network search strategy, focused on core journals and reference lists of related reviews. Twenty-nine studies were included. We developed thematic summaries framed by a realist approach of exploring interventions, their mechanisms, outcomes and how they are shaped by contexts. RESULTS: Reported outcomes of peer involvement included reduced HIV incidence and prevalence; increased service access, acceptability and quality; changed risk behaviours; and reduced stigma and discrimination. Mechanisms via which these roles work were trust, personal commitment and empathy, using community knowledge and experience, as well as ‘bridge’ and ‘role model’ processes. Contexts of criminalisation, under-resourced health systems, and stigma and discrimination were found to shape these roles, their mechanisms and outcomes. Though contexts and mechanisms are little explored within the literature, we identifed a common theme across contexts, mechanisms and outcomes. Peer outreach interventions work through trust, community knowledge and expertise, and ‘bridge’ mechanisms (M) to counter criminalisation and constraining clinic and service delivery environments (C), contributing towards changed drug-using behaviours, increased access, acceptability and quality of harm reduction services and decreased stigma and discrimination (O). CONCLUSION: Peer involvement in HIV and harm reduction services in low- and middle-income settings is linked to positive health outcomes, shaped by contexts of criminalisation, stigma, and resource scarcity. However, peer involvement is under-theorised, particularly on how contexts shape mechanisms and ultimately outcomes. Eforts to study peer involvement need to develop theory and methods to evaluate the complex mechanisms and contexts that have infuence. Finally, there is a need to expand the range of peer roles, to embrace the capacities and expertise of people who use drugs.

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Keywords

Rapid review, Community involvement, Harm reduction, Peer involvement, Human immunodeficiency virus (HIV), People who use drugs including people who inject drugs (PWUD/ID)

Sustainable Development Goals

Citation

Chang J, Shelly S, Busz M, Stoicescu C, Iryawan AR, Madybaeva D, de Boer Y, Guise A. Peer driven or driven peers? A rapid review of peer involvement of people who use drugs in HIV and harm reduction services in low- and middle-income countries. Harm Reduction Journal 2021 Feb 3;18(1):15. doi: 10.1186/s12954-021-00461-z.