Peer Education Intervention Reduced Sexually Transmitted Infections Among Male Tajik Labor Migrants Who Inject Drugs: Results of a Cluster-randomized Controlled Trial

Mary Ellen Mackesy-Amiti; Judith A Levy; Casey M Luc; Jonbek Jonbekov

doi:10.1101/2024.08.15.24312070

Peer Education Intervention Reduced Sexually Transmitted Infections Among Male Tajik Labor Migrants Who Inject Drugs: Results of a Cluster-randomized Controlled Trial

medRxiv [Preprint]. 2024 Dec 13:2024.08.15.24312070. doi: 10.1101/2024.08.15.24312070.

Authors

Mary Ellen Mackesy-Amiti¹, Judith A Levy¹, Casey M Luc¹, Jonbek Jonbekov²

Affiliations

¹ School of Public Health, University of Illinois Chicago, Chicago, USA.
² PRISMA Research Center, Dushanbe, Tajikistan.

Abstract

Background: In a cluster-randomized controlled trial, the "Migrants' Approached Self-Learning Intervention in HIV/AIDS for Tajiks" (MASLIHAT) reduced intervention participants' sexual risk behaviour including any condomless sex, condomless sex with female sex workers, and multiple sexual partners. This analysis investigates if observed changes in sexual risk behaviors translated into fewer reported STIs among participants over 12-month follow-up.

Methods: The MASLIHAT intervention was tested in a cluster-randomized controlled trial with sites assigned to either the MASLIHAT intervention or comparison health education training (TANSIHAT). Participants and network members (n=420) were interviewed at baseline and 3-month intervals for one year to assess HIV/STI sex and drug risk behaviour. We conducted mixed effects robust Poisson regression analyses to test for differences between conditions in self-reported STIs during 12 months of follow-up, and to test the contribution of sexual risk behaviours to STI acquisition. We then tested the mediating effects of sexual behaviours during the first six months following the intervention on STIs reported at the 9 and 12-month follow-up interviews.

Results: Participants in the MASLIHAT condition were significantly less likely to report an STI during follow-up (IRR=0.27, 95% CI 0.13-0.58). Condomless sex with a non-main (casual or commercial) partner was significantly associated with STI acquisition (IRR=2.30, 95% CI 1.26-4.21). Adjusting for condomless sex with a non-main partner, the effect of MASLIHAT intervention participation was reduced (IRR=0.36, 95% CI 0.16-0.80), signalling possible mediation. Causal mediation analysis indicated that the intervention's effect on reported STI was partially mediated by reductions among MASLIHAT participants in condomless sex with a non-main partner.

Conclusions: The MASLIHAT peer-education intervention reduced reported STIs among Tajik labour migrants partly through reduced condomless sex with casual and commercial partners.

Clinical trial registration: ClinicalTrials.gov, 2021-04-16, NCT04853394.

Keywords: drug users; migrant workers; sex workers; sexually transmitted diseases; unsafe sex.

Publication types

Preprint

Associated data

ClinicalTrials.gov/NCT04853394

Grants and funding

This research was supported by a grant from the National Institute on Drug Abuse of the National Institutes of Health (USA) under Award Number R01DA050464 and by a grant from the National Center for Advancing Translational Science, NIH, through grant UL1TR002003. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.