The efficacy of a peer-driven intervention (PDI), compared to a traditional outreach project, to combat the spread of HIV among injection drug users (IDUs) was demonstrated in a multi-site study from 1994-1998 in eastern Connecticut, directed by the PI of this proposal and funded by NlDA (R01 DA08014). The feasibility of a PDI in Russia to recruit and educate IDUs for HIV prevention was successfully demonstrated in a one- site study from 1996-1998, funded by the International Harm Reduction Development Program of the Open Society Institute, New York City. Further research is now required to improve the PDI model for further use in both the U.S. and abroad. We propose comparing a standard-PDI to a simplified-PDI in terms of recruitment power and educational efficacy to reduce IDU-risk behaviors in two sites in the oblast (province) of Yaroslavl, Russia: Bragino and Rybinsk. The goal is to recruit 500 IDUs at each site for a baseline and three, six-month follow-up health and risk assessment interviews. At both sites, IDUs will be offered recruitment coupons and nominal rewards to educate their peers in the community and recruit them to a project storefront. Each of their recruits will also be given the same education and recruitment opportunity. At three, six-month intervals all subjects will be given the opportunity to re-access and educate each of their original recruits in a new body of prevention information, and to re-recruit them to the project in each city for follow-up interviews and services. In the standard-PDI, subjects will be offered separate, nominal rewards for recruiting peers for services, and for educating them in the community. In the simplified-PDI, the subjects will be offered a flat reward for both educating and recruiting subjects. This modification will streamline the model's operation and make it less expensive, which will be advantageous if the simplified-PDI compares favorably with the standard-PDI in terms of recruitment power and educational effectiveness. The proposed study offers the United States an opportunity to improve the PDI model for more effective use at home while offering Russia urgently needed HIV prevention assistance to hundreds of IDUs in two different cities. The study is also in response to NIH's Global AIDS Research Initiative and Strategic Plan, established by the Office of AIDS Research for fiscal year 2003.
