Effects of a social network intervention on HIV seroconversion among people who inject drugs in Ukraine: moderation by network gender composition

BACKGROUND

Women who inject drugs in Ukraine are disproportionately burdened by HIV. To help address the needs of this population, a greater understanding of how interventions may uniquely benefit women who inject drugs is needed.

METHODS

Data come from a randomized controlled trial of a social network intervention targeting people who inject drugs in Ukraine (N = 1195). Indexes, plus two of their injection network members, received HIV testing and counseling (control arm) or HIV testing and counseling plus a social network intervention (intervention arm), in which indexes were trained to influence network members' risk behaviors. We used Cox regressions with interaction terms to assess differences in time to HIV seroconversion between arms by network gender composition and gender of the index. For significant interaction terms, we calculated simple effects, generated survival functions using Kaplan-Meier methods, and compared survival curves using log-rank tests.

RESULTS

At 12 months, there were 45 seroconversions among women (40.0 [28.3, 51.7] per 100 person years) and 111 among men (28.4 [23.1, 33.6] per 100 person years) in the control arm; there were 27 seroconversions among women (17.1 [10.7, 23.6] per 100 person years) and 77 among men (18.7 [14.5, 22.9] per 100 person years) in the intervention arm. Network gender composition (but not gender of the index) moderated the intervention effect on HIV incidence (p < 0.05). Specifically, the intervention appeared to be even more protective against HIV acquisition as female gender composition increased. In the intervention arm, the HIV seroconversion hazard rate was 44% lower with 1 network female; 61% lower with 2 network females; and 72% lower with 3 network females.

CONCLUSIONS

A greater number of women in an injection network, coupled with the provision of risk-reduction strategies, is associated with HIV risk-mitigation, though the mechanisms through which this occurs remain unclear. Findings can support new research and practice directions that prioritize women who inject drugs and more thoughtfully support their health and wellbeing.

Patients' and volunteer coaches' experiences with an informal social network intervention in forensic psychiatric care: a qualitative analysis

BACKGROUND

Improving supportive social networks in forensic psychiatric patients is deemed important due to the protective effects of such networks on both mental health problems and criminal recidivism. Informal interventions targeted at social network enhancement by community volunteers showed positive effects in various patient and offender populations. However, these interventions have not specifically been studied in forensic psychiatric populations. Therefore, forensic psychiatric outpatients' and volunteer coaches' experiences with an informal social network intervention were explored in this study.

METHODS

This qualitative study was based on semi-structured interviews conducted alongside an RCT. Forensic outpatients allocated to the additive informal social network intervention, and volunteer coaches, were interviewed 12 months after baseline assessment. Interviews were audio-recorded and transcribed verbatim. Reflexive thematic analysis was used to identify and report patterns in the data.

RESULTS

We included 22 patients and 14 coaches in the study. The analysis of interviews revealed five main themes reflecting patients' and coaches' experiences: (1) dealing with patient receptivity, (2) developing social bonds, (3) receiving social support, (4) achieving meaningful change, and (5) using a personalized approach. Patient receptivity, including willingness, attitudes, and timing, was a common reported barrier affecting patients' engagement in the intervention. Both patients' and coaches' experiences confirmed that the intervention can be meaningful in developing new social bonds between them, in which patients received social support. Despite, experiences of meaningful and sustainable changes in patients' social situations were not clearly demonstrated. Coaches' experiences revealed broadened worldviews and an enhanced sense of fulfillment and purpose. Finally, a personalized, relationship-oriented rather than goal-oriented approach was feasible and preferable.

CONCLUSION

This qualitative study showed positive experiences of both forensic psychiatric outpatients and volunteer coaches with an informal social network intervention in addition to forensic psychiatric care. Notwithstanding the limitations, the study suggests that these additive interventions provide an opportunity for forensic outpatients to experience new positive social interactions with individuals in the community, which can initiate personal development. Barriers and facilitators to engagement are discussed to improve further development and implementation of the intervention.

TRIAL REGISTRATION

This study is registered at the Netherlands Trial Register (NTR7163, registration date: 16/04/2018).

Injection Drug Use and Sexual Risk Behaviors Among People who Inject Drugs in Ukraine: A Random-Intercept Latent Transition Analysis

HIV transmission in Ukraine is driven in part by unsafe injection drug use and sexual risk behaviors among people who inject drugs. We performed a random-intercept latent transition analysis on responses to 9 binary injection drug use and sexual behavior items from 1195 people who inject drugs with negative HIV status enrolled in a clustered randomized clinical trial of a social network intervention in Odessa, Donetsk, and Nikolayev, Ukraine. We identified 5 baseline classes: "Social injection/equipment-sharing" (11.7%), "Social injection" (25.9%), "High-risk collective preparation/splitting" (17.0%), "Collective preparation/splitting" (11.3%), and "Dealer-facilitated injection" (34.1%). After 12 months, intervention participants were more likely to transition to the "Collective preparation/splitting" class, which featured the fewest risk behaviors. Transitioning from the "Collective preparation/splitting" to the "Social injection/equipment-sharing" class was associated with HIV acquisition for control participants. Research to illuminate the stability of these patterns and how they may benefit from uniquely tailored programming to reduce unsafe behaviors is needed.

Feasibility of a computer-assisted social network motivational interviewing intervention to reduce substance use and increase supportive connections among emerging adults transitioning from homelessness to housing

BACKGROUND

Social networks may play positive and negative roles in the lives of young adults experiencing homelessness (YEH) who are transitioning into housing. Social networks can influence their alcohol and/or other drug (AOD) use, as well as provide immediate and long-term support necessary for a successful transition.

METHODS

We adapted a four-session computer-assisted motivational interviewing social network intervention (MI-SNI) for YEH transitioning into housing. We iteratively adapted and beta tested the intervention for delivery by case managers at an organization that provides supportive housing to YEH. We conducted a focus group with agency staff (n = 6), role-play exercises with case managers (n = 3), and semi-structured interviews with residents (n = 6). Interview data were thematically analyzed with open coding. This study presents the first adaptation of an innovative social network-based motivational intervention to reduce AOD use and increase stable, prosocial supportive connections via visualizations of the structure and composition of the individual's social network.

RESULTS

Participants rated sessions as "moderately" to "very" helpful and "good" quality on average. Participants agreed that the sessions were helpful, understandable, and satisfying and would work for new residents. Themes emerged in four broad categories: (1) Acceptability, (2) Positive benefits, (3) Visualization reactions, and (4) MI-SNI interface reactions. For the acceptability category, three sub-themes emerged: (1) understandability, (2) enjoyability and ease of use, (3) and barriers to acceptability. Five sub-themes emerged about the intervention's likelihood to trigger positive benefits: (1) learning/new insights, (2) enhancement to motivation to change, (3) making AOD changes, (4) building social support, and (5) the intervention's usefulness to some but not others. Five sub-themes also emerged from comments about the social network visualizations: (1) general positive comments, (2) understandability, (3) new insights, (4) triggering changes in social support, and (5) triggering changes in AOD use. When discussing the MI-SNI intervention interface beyond the visualizations, discussions emerged in three thematic categories: (1) discussion of name listing, (2) discussion of screen wording, and (3) the use of a computer interface to deliver the intervention.

CONCLUSIONS

Results suggest that the MI-SNI is acceptable to YEH and can be feasibly delivered by case managers during case management sessions. Trial registration ClinicalTrials.gov Identifier: NCT04637815. Registered November 10, 2020.

Feasibility study of peer-led and school-based social network Intervention (STASH) to promote adolescent sexual health

Background

Effective sex education is the key to good sexual health. Peer-led approaches can augment teacher-delivered sex education, but many fail to capitalise on mechanisms of social influence. We assessed the feasibility of a novel intervention (STASH) in which students (aged 14–16) nominated as influential by their peers were recruited and trained as Peer Supporters (PS). Over a 5–10-week period, they spread positive sexual health messages to friends in their year group, both in-person and via social media, and were supported to do so via weekly trainer-facilitated meetings. The aims of the study were to assess the feasibility of STASH (acceptability, fidelity and reach), to test and refine the programme theory and to establish whether the study met pre-set progression criteria for continuation to larger-scale evaluation.

Methods

The overall design was a non-randomised feasibility study of the STASH intervention in 6 schools in Scotland. Baseline (n=680) and follow-up questionnaires (approx. 6 months later; n=603) were administered to the intervention year group. The control group (students in year above) completed the follow-up questionnaire only (n=696), 1 year before the intervention group. The PS (n=88) completed a brief web survey about their experience of the role; researchers interviewed participants in key roles (PS (n=20); PS friends (n=22); teachers (n=8); trainers (n=3)) and observed 20 intervention activities. Activity evaluation forms and project monitoring data also contributed information. We performed descriptive quantitative analysis and thematic qualitative analysis.

Results

The PS role was acceptable; on average across schools >50% of students nominated as influential by their friends, signed up and were trained (n=104). This equated to 13% of the year group. Trained PS rarely dropped out (97% completion rate) and 85% said they liked the role. Fidelity was good (all bar one trainer-led activity carried out; PS were active). The intervention had good reach; PS were reasonably well connected and perceived as ‘a good mix’ and 58% of students reported exposure to STASH. Hypothesised pre-conditions, contextual influences and mechanisms of change for the intervention were largely confirmed. All bar one of the progression criteria was met.

Conclusion

The weight of evidence supports continuation to full-scale evaluation.

Trial registration

Current controlled trials ISRCTN97369178

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-021-00835-x.

Promoting water consumption among children: a three-arm cluster randomised controlled trial testing a social network intervention

Objective:

To test the effectiveness of a social network intervention (SNI) to improve children’s healthy drinking behaviours.

Design:

A three-arm cluster randomised control trial design was used. In the SNI, a subset of children were selected and trained as ‘influence agents’ to promote water consumption–as an alternative to sugar-sweetened beverages (SSB)–among their peers. In the active control condition, all children were simultaneously exposed to the benefits of water consumption. The control condition received no intervention.

Setting:

Eleven schools in the Netherlands.

Participants:

Four hundred and fifty-one children (M_age = 10·74, SD_age = 0·97; 50·8 % girls).

Results:

Structural path models showed that children exposed to the SNI consumed 0·20 less SSB per day compared to those in the control condition (β = 0·25, P = 0·035). There was a trend showing that children exposed to the SNI consumed 0·17 less SSB per day than those in the active control condition (β = 0·20, P = 0·061). No differences were found between conditions for water consumption. However, the moderation effects of descriptive norms (β = –0·12, P = 0·028) and injunctive norms (β = 0·11–0·14, both P = 0·050) indicated that norms are more strongly linked to water consumption in the SNI condition compared to the active control and control conditions.

Conclusions:

These findings suggest that a SNI promoting healthy drinking behaviours may prevent children from consuming more SSB. Moreover, for water consumption, the prevailing social norms in the context play an important role in mitigating the effectiveness of the SNI.

Improving mental wellbeing of forensic psychiatric outpatients through the addition of an informal social network intervention to treatment as usual: a randomized controlled trial

BACKGROUND

Forensic psychiatric patients often suffer from a multitude of severe psychiatric and social problems. Meanwhile multimodal evidence-based interventions are scarce and treatment effectiveness is in need of improvement. The main goal of forensic psychiatric treatment is to address psychiatric and social factors and thereby mitigate criminal behaviour. Notably, a supportive social network is an important protective factor for criminal behaviour. As such, improving a poor social network may decrease the risk of criminal recidivism. This study aims to examine the effectiveness of the addition of an informal social network intervention (FNC) to treatment as usual (TAU) among forensic psychiatric outpatients.

METHODS

In a mono-center randomized controlled clinical trial with two parallel groups, forensic psychiatric outpatients with social network-related problems (N = 105) will be allocated to either TAU + FNC or TAU alone. The informal social network intervention consists of a 12-month coaching intervention, performed by the forensic network coach (a volunteer trained by an informal care institute). Assessments will be conducted at baseline and 3 months, 6 months, 9 months, 12 months, and 18 months after baseline. The primary outcome variable is mental wellbeing. Psychiatric functioning, criminal recidivism, substance abuse, quality of life, social network, social support, loneliness and self-sufficiency are included as secondary outcomes. A variety of potential mediators and moderators of effectiveness will be explored. Additionally, a qualitative evaluation of effectiveness will be performed.

DISCUSSION

This study will contribute to the existing literature of forensic treatment effectiveness as it is the first RCT examining the effectiveness of adding a social network intervention in a forensic outpatient population. If effectiveness is shown, forensic mental health care could be optimized by collaborating with informal care or community initiatives aimed at improving a positive social network. In addition, results will provide insight regarding mediators and moderators of treatment effectiveness.

TRIAL REGISTRATION

This study is registered at the Netherlands Trial Register ( NTR7163 ). Date of registration: 16 april 2018.

A randomized controlled trial testing a social network intervention to promote physical activity among adolescents

BACKGROUND

The current study examined the effectiveness of a social network intervention to promote physical activity among adolescents. Social network interventions utilize peer influence to change behavior by identifying the most influential individuals within social networks (i.e., influence agents), and training them to promote the target behavior.

METHOD

A total of 190 adolescents (46.32% boys; M age = 12.17, age range: 11-14 years) were randomly allocated to either the intervention or control condition. In the intervention condition, the most influential adolescents (based on peer nominations of classmates) in each classroom were trained to promote physical activity among their classmates. Participants received a research smartphone to complete questionnaires and an accelerometer to measure physical activity (steps per day) at baseline, and during the intervention one month later.

RESULTS

A multilevel model tested the effectiveness of the intervention, controlling for clustering of data within participants and days. No intervention effect was observed, b = .04, SE = .10, p = .66.

CONCLUSION

This was one of the first studies to test whether physical activity in adolescents could be promoted via influence agents, and the first social network intervention to use smartphones to do so. Important lessons and implications are discussed concerning the selection criterion of the influence agents, the use of smartphones in social network intervention, and the rigorous analyses used to control for confounding factors.

TRIAL REGISTRATION

Dutch Trial Registry (NTR): NTR6173 . Registered 5 October 2016 Study procedures were approved by the Ethics Committee of the Radboud University (ECSW2014-100614-222).

Youth's social network structures and peer influences: study protocol MyMovez project - Phase I

Background

Youth are an important target group for social network interventions, because they are particularly susceptible to the adaptation of healthy and unhealthy habits and behaviors of others. They are surrounded by ‘social influence agents’ (i.e., role models such as family, friends and peers) that co-determine their dietary intake and physical activity. However, there is a lack of systematic and comprehensive research on the implementation of a social network approach in health campaigns. The MyMovez research project aims to fill this gap by developing a method for effective social network campaign implementation. This protocol paper describes the design and methods of Phase I of the MyMovez project, aiming to unravel youth’s social network structures in combination with individual, psychosocial, and environmental factors related to energy intake and expenditure. In addition, the Wearable Lab is developed to enable an attractive and state-of-the-art way of collecting data and online campaign implementation via social networks.

Methods

Phase I of the MyMovez project consists of a large-scale cross-sequential cohort study (N = 953; 8-12 and 12-15 y/o). In five waves during a 3-year period (2016-2018), data are collected about youth’s social network exposure, media consumption, socialization experiences, psychological determinants of behavior, physical environment, dietary intake (snacking and drinking behavior) and physical activity using the Wearable Lab. The Wearable Lab exists of a smartphone-based research application (app) connected to an activity tracking bracelet, that is developed throughout the duration of the project. It generates peer- and self-reported (e.g., sociometric data and surveys) and experience sampling data, social network beacon data, real-time physical activity data (i.e., steps and cycling), location information, photos and chat conversation data from the app’s social media platform Social Buzz.

Discussion

The MyMovez project - Phase I is an innovative cross-sequential research project that investigates how social influences co-determine youth’s energy intake and expenditure. This project utilizes advanced research technologies (Wearable Lab) that provide unique opportunities to better understand the underlying processes that impact youths’ health-related behaviors. The project is theoretically and methodologically pioneering and produces a unique and useful method for successfully implementing and improving health campaigns.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5353-5) contains supplementary material, which is available to authorized users.

Social Network Strategies to Address HIV Prevention and Treatment Continuum of Care Among At-risk and HIV-infected Substance Users: A Systematic Scoping Review

Social network analysis (SNA) and social network-based interventions (SNI) are important analytical tools harnessing peer and family influences critical for HIV prevention and treatment among substance users. While SNA is an effective way to measure social network influences, SNI directly or indirectly involves network members in interventions. Even though these methods have been applied in heterogeneous ways, leading to extensive evidence-based practices, systematic reviews are however, lacking. We searched five bibliographic databases and identified 58 studies involving HIV in substance users that had utilized SNA or SNI as part of their methodology. SNA was used to measure network variables as inputs in statistical/mathematical models in 64 % of studies and only 22 % of studies used SNI. Most studies focused on HIV prevention and few addressed diagnosis (k = 4), care linkage and retention (k = 5), ART adherence (k = 2), and viral suppression (k = 1). This systematic review highlights both the advantages and disadvantages of social network approaches for HIV prevention and treatment and gaps in its use for HIV care continuum.

Feasibility of a computer-assisted social network motivational interviewing intervention for substance use and HIV risk behaviors for housing first residents

Background

Social networks play positive and negative roles in the lives of homeless people influencing their alcohol and/or other drug (AOD) and HIV risk behaviors.

Methods

We developed a four-session computer-assisted social network motivational interviewing intervention for homeless adults transitioning into housing. We examined the acceptability of the intervention among staff and residents at an organization that provides permanent supportive housing through iterative rounds of beta testing. Staff were 3 men and 3 women who were residential support staff (i.e., case managers and administrators). Residents were 8 men (7 African American, 1 Hispanic) and 3 women (2 African American, 1 Hispanic) who had histories of AOD and HIV risk behaviors. We conducted a focus group with staff who gave input on how to improve the delivery of the intervention to enhance understanding and receptivity among new residents. We conducted semi-structured qualitative interviews and collected self-report satisfaction data from residents.

Results

Three themes emerged over the course of the resident interviews. Residents reported that the intervention was helpful in discussing their social network, that seeing the visualizations was more impactful than just talking about their network, and that the intervention prompted thoughts about changing their AOD use and HIV risk networks.

Conclusions

This study is the first of its kind that has developed, with input from Housing First staff and residents, a motivational interviewing intervention that targets both the structure and composition of one’s social network. These results suggest that providing visual network feedback with a guided motivational interviewing discussion is a promising approach to supporting network change.

ClinicalTrials.gov Identifier NCT02140359

A social network-based intervention stimulating peer influence on children's self-reported water consumption: A randomized control trial

The current pilot study examined the effectiveness of a social network-based intervention using peer influence on self-reported water consumption. A total of 210 children (52% girls; M age = 10.75 ± SD = 0.80) were randomly assigned to either the intervention (n = 106; 52% girls) or control condition (n = 104; 52% girls). In the intervention condition, the most influential children in each classroom were trained to promote water consumption among their peers for eight weeks. The schools in the control condition did not receive any intervention. Water consumption, sugar-sweetened beverage (SSB) consumption, and intentions to drink more water in the near future were assessed by self-report measures before and immediately after the intervention. A repeated measure MANCOVA showed a significant multivariate interaction effect between condition and time (V = 0.07, F(3, 204) = 5.18, p = 0.002, pη(2) = 0.07) on the dependent variables. Further examination revealed significant univariate interaction effects between condition and time on water (p = 0.021) and SSB consumption (p = 0.015) as well as water drinking intentions (p = 0.049). Posthoc analyses showed that children in the intervention condition reported a significant increase in their water consumption (p = 0.018) and a decrease in their SSB consumption (p < 0.001) over time, compared to the control condition (p-values > 0.05). The children who were exposed to the intervention did not report a change in their water drinking intentions over time (p = 0.576) whereas the nonexposed children decreased their intentions (p = 0.026). These findings show promise for a social network-based intervention using peer influence to positively alter consumption behaviors.

TRIAL REGISTRATION

This RCT was registered in the Australian New Zealand Clinical Trials Registry (ACTRN12614001179628). Study procedures were approved by the Ethics Committee of the Faculty of Social Sciences at Radboud University (ECSW2014-1003-203).

A computer-assisted motivational social network intervention to reduce alcohol, drug and HIV risk behaviors among Housing First residents

BACKGROUND

Individuals transitioning from homelessness to housing face challenges to reducing alcohol, drug and HIV risk behaviors. To aid in this transition, this study developed and will test a computer-assisted intervention that delivers personalized social network feedback by an intervention facilitator trained in motivational interviewing (MI). The intervention goal is to enhance motivation to reduce high risk alcohol and other drug (AOD) use and reduce HIV risk behaviors.

METHODS/DESIGN

In this Stage 1b pilot trial, 60 individuals that are transitioning from homelessness to housing will be randomly assigned to the intervention or control condition. The intervention condition consists of four biweekly social network sessions conducted using MI. AOD use and HIV risk behaviors will be monitored prior to and immediately following the intervention and compared to control participants' behaviors to explore whether the intervention was associated with any systematic changes in AOD use or HIV risk behaviors.

DISCUSSION

Social network health interventions are an innovative approach for reducing future AOD use and HIV risk problems, but little is known about their feasibility, acceptability, and efficacy. The current study develops and pilot-tests a computer-assisted intervention that incorporates social network visualizations and MI techniques to reduce high risk AOD use and HIV behaviors among the formerly homeless. CLINICALTRIALS.

GOV IDENTIFIER

NCT02140359.