title: Interrupting the social processes linked with initiation of injection drug use: results from a pilot study.
abstract: BACKGROUND
  Injection drug use is a skill learned in social settings. Change the Cycle (CTC), a peer-delivered, one-session intervention, is designed to reduce among people who inject drugs (PIDs) injection initiation-related behaviours (i.e., speaking positively about injecting to non-injectors, injecting in front of non-injectors, explaining or showing a non-injector how to inject) and initiation of non-injectors. We hypothesized that participation in CTC would lead to reductions in initiation-related behaviours six months later.
  
  
  METHODS
  Using respondent driven sampling (RDS), 98 PIDs were recruited in Toronto, Canada to participate in pilot testing of CTC. The baseline session consisted of a structured interview, the peer-delivered CTC intervention, instructions regarding RDS coupon distribution, and an invitation to return in six months for a follow-up interview. For the 84 PIDs completing the six-month interview, we compared initiation-related behaviours at baseline with six-month follow-up.
  
  
  RESULTS
  The proportion of PIDs offering to initiate a non-injector was reduced from 8.4% (95% CI: 2.5, 15.9) at baseline to 1.59% (95% CI: 0.4, 3.7) at 6-month follow-up. The prevalence of speaking positively about injection to non-injectors also decreased significantly. The proportion of PIDs who helped a non-injector with a first injection at baseline was 6.2% (95% CI: 2.1, 11.3) and at follow-up was 3.5% (95% CI: 0.8, 7.1). Paired analyses of initiator baseline versus follow-up data showed a 72.7% reduction in initiation (95%CI: 47.7, 83.1).
  
  
  CONCLUSIONS
  While further refinements remain to be tested, pilot study results suggest that CTC holds promise as a prevention intervention.
authors: Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada; Social and Epidemiological Research Department, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON M5S 2S1, Canada. Electronic address: carol.strike@utoronto.ca.
authors: C
authors: C
authors: Strike
authors: School of Kinesiology and Health Science, Faculty of Health, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada.
authors: M
authors: M
authors: Rotondi
authors: Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada.
authors: G
authors: G
authors: Kolla
authors: Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Campus Longueuil 1111, rue St-Charles Ouest, Longueuil, QC J4K 5G4, Canada.
authors: É
authors: É
authors: Roy
authors: Social and Epidemiological Research Department, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON M5S 2S1, Canada.
authors: N K
authors: NK
authors: Rotondi
authors: Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada; Social and Epidemiological Research Department, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON M5S 2S1, Canada.
authors: K
authors: K
authors: Rudzinski
authors: South Riverdale Community Health Centre, 955 Queen Street East, Toronto, ON M4M 3P3, Canada.
authors: R
authors: R
authors: Balian
authors: Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada.
authors: T
authors: T
authors: Guimond
authors: Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada.
authors: R
authors: R
authors: Penn
authors: South Riverdale Community Health Centre, 955 Queen Street East, Toronto, ON M4M 3P3, Canada.
authors: R B
authors: RB
authors: Silver
authors: Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada.
authors: M
authors: M
authors: Millson
authors: South Riverdale Community Health Centre, 955 Queen Street East, Toronto, ON M4M 3P3, Canada.
authors: K
authors: K
authors: Sirois
authors: South Riverdale Community Health Centre, 955 Queen Street East, Toronto, ON M4M 3P3, Canada.
authors: J
authors: J
authors: Altenberg
authors: Centre for Research on Drugs and Health Behaviour, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
authors: N
authors: N
authors: Hunt
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010379:Peer Group; D010865:Pilot Projects; D012919:Social Behavior; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology*; D055815:Young Adult
keywords: HIV prevention; Initiation; Injection drug use; Peer intervention