High Risk Crack Use Settings and HIV in El Salvador

Overview

This project will first increase the accessibility and acceptability of rapid HIV testing in health clinics located in or near four low-income communities in San Salvador, El Salvador. The investigators will use crack users' social networks and small incentives, as recommended by the CDC, in collaboration with the Salvadoran Ministry of Public Health and Social Assistance (MSPAS) to encourage crack users to receive HIV testing. The second part of the intervention consists of training 8 Peer Leaders to recruit and lead a Peer Network Intervention among 400 crack users to change norms supporting HIV protective behaviors. The intervention will include monthly meetings open to crack using and non-crack using community residents to reinforce HIV risk reduction skills, and discussion of other topics related to HIV such as illicit drug use and interpersonal violence and community-wide HIV awareness events. Our hypothesis is that these two intervention features will singly, and in combination, reduce HIV risk behaviors among Salvadoran crack users.

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Non-Randomized
    • Intervention Model: Single Group Assignment
    • Primary Purpose: Prevention
    • Masking: None (Open Label)
  • Study Primary Completion Date: June 2016

Interventions

  • Behavioral: Social Network HIV Testing
    • Crack users will be recruited for HIV testing and receive 3 coupons to recruit other crack users for HIV testing.
  • Behavioral: Peer Network Intervention
    • Peer leaders will recruit small networks of crack users and facilitate a three-day prevention intervention.

Arms, Groups and Cohorts

  • Experimental: Social Network HIV Testing
    • Participants in this arm will be recruited through social networks and will receive an HIV test.
  • Experimental: Peer Network Intervention
    • Eight (8) current or former crack users will be recruited to facilitate small networks of crack users in a three-day intervention. They will also facilitate monthly meetings open to all community members regarding HIV prevention and interpersonal violence.

Clinical Trial Outcome Measures

Primary Measures

  • Increased HIV testing rates among crack users
    • Time Frame: 24 months
  • Decreased number of sexual risk behaviors among crack users
    • Time Frame: 12 months

Secondary Measures

  • Community and organizational factors associated with successful implementation of multi-level, community-based HIV prevention intervention
    • Time Frame: 12 months

Participating in This Clinical Trial

Inclusion Criteria

  • 18 years or older – used crack cocaine in the last 2 weeks Exclusion Criteria:

  • not giving informed consent – under 18 years of age – considered by research staff to be unfit or unable to give informed consent – engages in continued disruptive behavior while participating in the project – not using crack or cocaine in the last month

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: Accepts Healthy Volunteers

Investigator Details

  • Lead Sponsor
    • Medical College of Wisconsin
  • Collaborator
    • National Institute on Drug Abuse (NIDA)
  • Provider of Information About this Clinical Study
    • Principal Investigator: Julia Dickson-Gomez, Associate Professor – Medical College of Wisconsin
  • Overall Official(s)
    • Julia B. Dickson-Gomez, Ph.D., Principal Investigator, Medical College of Wisconsin
    • Gloria Bodnar, Ph.D., Study Director, Fundacion Antidrogas de El Salvador (FUNDASALVA)

References

Dickson-Gomez J, Bodnar G, Petroll A, Johnson K, Glasman L. HIV Treatment for Alcohol and Non-Injection Drug Users in El Salvador. Qual Health Res. 2015 Dec;25(12):1719-32. doi: 10.1177/1049732314568322. Epub 2015 Jan 16.

Dickson-Gomez J, Corbett AM, Bodnar G, Zuniga MO, Guevara CE, Rodriguez K, Navas V. Context and group dynamics in a CBPR-developed HIV prevention intervention. Health Promot Int. 2016 Mar;31(1):93-105. doi: 10.1093/heapro/dau058. Epub 2014 Jul 28.

Dickson-Gomez J. Substance abuse disorders treatment in El Salvador: analysis of policy-making-related failure. Subst Use Misuse. 2012 Nov-Dec;47(13-14):1546-51. doi: 10.3109/10826084.2012.705698.

Dickson-Gomez J, McAuliffe T, Rivas de Mendoza L, Glasman L, Gaborit M. The relationship between community structural characteristics, the context of crack use, and HIV risk behaviors in San Salvador, El Salvador. Subst Use Misuse. 2012 Feb;47(3):265-77. doi: 10.3109/10826084.2011.635325.

Dickson-Gomez J, Bodnar G, Guevara CE, Rodriguez K, De Mendoza LR, Corbett AM. With God's help i can do it: crack users? Formal and informal recovery experiences in El Salvador. Subst Use Misuse. 2011;46(4):426-39. doi: 10.3109/10826084.2010.495762. Epub 2010 Aug 24.

Dickson-Gomez J. Structural factors influencing patterns of drug selling and use and HIV risk in the San Salvador metropolitan area. Med Anthropol Q. 2010 Jun;24(2):157-81. doi: 10.1111/j.1548-1387.2010.01095.x.

Dickson-Gomez J, Corbett AM, Bodnar G, Rodriguez K, Guevara CE. Resources and obstacles to developing and implementing a structural intervention to prevent HIV in San Salvador, El Salvador. Soc Sci Med. 2010 Feb;70(3):351-359. doi: 10.1016/j.socscimed.2009.10.029. Epub 2009 Nov 10. Erratum In: Soc Sci Med. 2010 Sep;71(5):1047.

Citations Reporting on Results

Glasman LR, Dickson-Gomez J, Lechuga J, Tarima S, Bodnar G, de Mendoza LR. Using Peer-Referral Chains with Incentives to Promote HIV Testing and Identify Undiagnosed HIV Infections Among Crack Users in San Salvador. AIDS Behav. 2016 Jun;20(6):1236-43. doi: 10.1007/s10461-015-1267-8.

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