Analysis Results of Quantitative Study Data Conducted Among Beneficiaries partipating in Peer-Driven Intervention STUDY REPORT Georgian Harm Reduction Network Tbilisi 2019 Acknowledgements This study report represents united efforts of many organizations and without their active involvements and support, introduction of the study results would be impossible. We express our gratitude to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and the National Center for Disease Control and Public Health for financial support of the study. We appreciate the centers of the Georgian Harm Reduction Network for providing field works for the study, in particular, for performing face-to-face interviews and data entry: Psycho-Social Information and Consultation Center “New Way”-Natalia Chirikashvili (Tbilisi), Davit Porchkhidze (Kutaisi), Nestor Maisadze (Samtredia) Union “New Vector” –Manana Khikhadze, Dimitri Tsiklauri (Tbilisi), Elene Qajaia (Rustavi) Union “Imedi” -Tamuna Esebua (Batumi) Union “Step To The Future”-Nino Beruashvili (Borjomi), Mariam Baindurashvili, Nino Tabuashvili (Gori), Nino Shavgulidze (Telavi) Association of National Development of Education, Social Rehabilitation and Historic Values Protection “Ordu”-Liana Topuria, Lela Kurashvili (Poti) Association of Young Psychologists and Doctors “Xenon” –Tsira Egutia, Medea Chichalava (Zugdidi). Hepa Plus-Maka Revishvili, Tamuna Kiladze (Tbilisi), Lia Tsikarishvili (Akhaltsikhe) International Organization for Women “Akeso”-Irina Fatsatsia, Gela Lashkhia (Tbilisi) Fenix-2009-Enri Maminashvili (Ozurgeti) We express many thanks to the administrative unit of the management of the Georgian Harm Reduction Network for on-line data monitoring and quality control (Khatuna Kutateladze, Guranda Jiqia, Marine Gogia). We express special gratitude to all beneficiaries, who have taken their time and agreed to participate in the study. Without trust of each respondent and contribution he/she has made, conduction of this study would not be manageable. The stury report has been preparated by the professor of addiction studies of Ilia State University, Irma Kirtadze (doctor). 2 Table of Content ABBREVATIONS USED 2 INTRODUCTION ERROR! BOOKMARK NOT DEFINED. PEER-DRIVEN INTERVENTION IN GEORGIA .................................................... ERROR! BOOKMARK NOT DEFINED. STUDY PURPOSE ................................................................................. ERROR! BOOKMARK NOT DEFINED. STUDY TASKS ...................................................................................... ERROR! BOOKMARK NOT DEFINED. METHODOLOGY 5 STUDY DESIGN ..................................................................................... ERROR! BOOKMARK NOT DEFINED. ETHICAL ISSUE OF STUDY .......................................................................... ERROR! BOOKMARK NOT DEFINED. INSTRUMENT ....................................................................................... ERROR! BOOKMARK NOT DEFINED. SAMPLING .......................................................................................... ERROR! BOOKMARK NOT DEFINED. DATA COLLECTION AND ANALYSIS ............................................................... ERROR! BOOKMARK NOT DEFINED. STUDY LIMITATIONS ............................................................................ ERROR! BOOKMARK NOT DEFINED. STUDY RESULTS ERROR! BOOKMARK NOT DEFINED. RECRITMENT CHAIN OF THE STUDY ....................................................... ERROR! BOOKMARK NOT DEFINED. DEMOGRAPHIC DATA .......................................................................... ERROR! BOOKMARK NOT DEFINED. INJECTION DRUG USE PRACTICE ............................................................. ERROR! BOOKMARK NOT DEFINED. RISK ASSESSMENT BATTERY .................................................................. ERROR! BOOKMARK NOT DEFINED. ASSESSMENT OF EDUCATOIN ON TRANSMISSION OF INFECTION ................ ERROR! BOOKMARK NOT DEFINED. ASSESSMENT OF EDUCATION AND PRACTICE ON TRANSMISSION OF HEPATITIS C ..... ERROR! BOOKMARK NOT DEFINED. BASIC FINDINGS AND RECOMMENDATIONS ERROR! BOOKMARK NOT DEFINED. BIBLIOGRAPHY 36 APEENDICES 39 APPENDIX N1. REPORT OF ETHICAL COMMISSION ................................................................................ 39 APPENDIX N2. STUDY QUESTIONARRIE ............................................................................................. 39 APPENDIX N3. INFORMED CONSENT ............................................................................................. 39 APPENDIX N4. PDI RECRUITING CHAIN ACCORDING TO THE CITIES ............................................................ 39 Abbreviations PDI Peer-driven Intervention PWID Injection drug user HIV Human Immunodeficiency Virus OST Opioid Substitution Therapy NSP Needle and Syringe Program AIDS Acquired Immune Deficiency Syndrome VCT Voluntary Counselling and Testing WHO World Health Organization GHRN Georgian Harm Reduction Network RDSAT Respondent-Driven Sampling Analysis Tool NetDraw Network Graphic Image Instrument SPSS Statistical Package for Social Sciences STI Sexually Transmitted Infections CI Confidence Interval OR Odds ratio SD Standard Deviation 2 Introduction Peer-Driven Intervention in Georgia Peer-driven intervention (PDI) managed by peers themselves for HIV-AIDS prevention was established in the 90s of the 20th century by Robert Brodhead and Douglas Hackathorn in the University of Connecticut with the support of US National Institute on Drug Abuse (Broadhead et al., 1998). The purpose of the intervention is to increase the knowledge about the harm induced by drug use (among them combined psychoactive substances, alcohol and other preparations) via peer-to-peer education in the PWID population as well increase of awareness on overdose, injection and sexual risky behaviors, hepatitis B and C, syphilis, infection prevention and decrease of risks related to drug use. Field and educational activities are effective means to reduce risky injection practice (Georgina J. MacArthur et al., 2014; Medley, Kennedy, O’Reilly, & Sweat, 2009) with the help of field work and educational programs based on peer-to-peer principle, during the six-month intervention, the rate for risky injection practice has decreased by 76% in the study environment (Garfein et al., 2007); such intervention makes an important contribution to reduce HIV transmission and supports reduction of hepatitis C transmission (Georgina J. MacArthur et al., 2014); filed work is an effective way to reach to undetected, hard to access population, who does not have any accessibility to the services. Behavior interventions among them peer-driven one support safe behavior, reduce transmission risk of HIV and hepatitis C and increase accessibility to health-care services (Garfein et al., 2007; Latka et al., 2008); results of cost-benefit modelling confirm cost-effectiveness of field interventions (Ritter & Cameron, 2005). Peer-driven methodology is based on an assumption that compared to paid outreach workers of HIV prevention programs, PWID have more access, communication and knowledge share ability to each other1: they provide education on issues for HIV prevention, carry out their attraction/recruitment in HIV prevention services offerin HIV counselling and testing, health and risk assessment, provision of sterile injection devices, condoms and educational materials. მიწოდებას. In Georgia, peer-driven intervention was introduced by the Georgian Harm Reduction Network in 2010 and after that it has been carried out annually in an uninterrupted regimen in the harm reduction service centers. For this purpose, 8 educational modules were developed (information of key importance, which is necessary to be disseminated in PWID population; for example: ways of transmission for HIV and B/C hepatitis, harm caused by home-made stimulators, signs of overdose, first aid upon overdose induced by opioids and so on), which should be updated periodically based on need and importance. The main motivation of this 1 Extensions of Respondent-Driven Sampling: A New Approach to the Study of Injection Drug Users Aged 18–25, Douglas D. Hackathon, Salaam Semaan, Robert S. Broadhead, and James J. Hughes, AIDS and Behavior, Vol. 6, No. 1, March 2002 3 intervention was to attract hard to access sub-populations-women and young people (18-24) in harm reduction services, as well as involvement of those persons who had never been provided services of AIDS prevention programs. With the help of this intervention it became possible to achieve the purpose set and enlargement of quantitative coverage2 (table 1). This approach has been applied with success to cover large part of drug users of various groups (for example, stimulators)3. Peers, who are involved in PDI, support widespread of information related to HIV- AIDS prevention and safe drug use. TABLE 1. NUMBER OF PWID COVERED BY PDI years 2010 2011 2012 2013 2014 2015 2016 2017 2018-19 PDI 781 106 2,356 3,755 4,032 1,940 384 746 1990 coverage Benefit of PDI besides fast dissemination of information in an effective way is to discover new unreachable population and offer and involve them in harm reduction services. Intervention and study of participants involved in intervention go underway in parallel and it is based on the appropriate protocol developed by the Harm Reduction Network in 2010 and its review and update takes place every year. Study Purpose Since 2010 PDI has been carried out year over year, this process is accompanied by data collection.