Peer-delivered Intervention Research Articles

Peer Intervention to Link Overdose Survivors to Treatment (PILOT): Protocol for a Multisite, Randomized Controlled Trial Conducted Within the National Institute on Drug Abuse Clinical Trials Network.

The increase in opioid-related overdoses has caused a decrease in average life expectancy, highlighting the need for effective interventions to reduce overdose risk and prevent subsequent overdoses. Peer support specialists (PSSs) offer an appealing strategy to engage overdose survivors and reduce overdose risk, but randomized controlled trials are needed to formalize peer-led interventions and evaluate their effectiveness. This National Institute on Drug Abuse Clinical Trials Network (CTN) study is a multisite, prospective, pilot randomized (1:1) controlled trial (CTN protocol 0107) that aims to evaluate the effectiveness of an emergency department (ED)-initiated, peer-delivered intervention tailored for opioid overdose survivors (PeerIntervention to Link Overdose survivors toTreatment [PILOT]), compared with treatment as usual (TAU). This study evaluates the effectiveness of the 6-month, PSS-led PILOT intervention compared with TAU on the primary outcome of reducing overdose risk behavior 6 months after enrollment. Adults (aged ≥18 years; N=150) with a recent opioid-related overdose were identified and approached in the ED. Participants were screened and enrolled, either in the ED or within 7 days of ED discharge at research offices or in the community and then asked to complete study visits at months 1, 3, 6 (end of intervention), and 7 (follow-up). Participants were enrolled at 3 study sites in the United States: Greenville, South Carolina; Youngstown, Ohio; and Everett, Washington. Participants randomized to the PILOT intervention received a 6-month, PSS-led intervention tailored to each participant's goals to reduce their overdose risk behavior (eg, overdose harm reduction, housing, medical, and substance use treatment or recovery goals). Participants randomized to TAU received standard-of-care overdose materials, education, and services provided through the participating EDs. This paper describes the study protocol and procedures, explains the design and inclusion and exclusion decisions, and provides details of the peer-led PILOT intervention and supervision of PILOT PSSs. Study enrollment opened in December 2021 and was closed in July 2023. A total of 150 participants across 3 sites were enrolled in the study, meeting the proposed sample size for the trial. Primary and secondary analyses are underway and expected to be published in early 2025. There is an urgent need to better understand the characteristics of overdose survivors presenting to the ED and for rigorous trials evaluating the effectiveness of PSS-led interventions on engaging overdose survivors and reducing overdose risk. Results from this pilot randomized controlled trial will provide a description of the characteristics of overdose survivors presenting to the ED; outline the implementation of PSS services research in ED settings, including PSS implementation of PSS supervision and activity tracking; and inform ED-initiated PSS-led overdose risk reduction interventions and future research to better understand the implementation and efficacy of these interventions. ClinicalTrials.gov NCT05123027; https://clinicaltrials.gov/study/NCT05123027. DERR1-10.2196/60277.

Study protocol of a randomized trial of STRIPES: a schoolyear, peer-delivered high school intervention for students with ADHD

BackgroundYouth with ADHD are at risk of academic impairments, dropping out of high school, and dysfunction in young adulthood. Interventions delivered early in high school could prevent these harmful outcomes, yet few high school students with ADHD receive treatment due to limited access to intervention providers. This study will test a peer-delivered intervention (STRIPES) for general education 9th grade students with impairing ADHD symptoms.MethodsA type 1 hybrid effectiveness-implementation design will be used to evaluate the effectiveness of STRIPES and explore the intervention’s implementability. Analyses will test the impact of STRIPES vs. enhanced school services control on target mechanisms and determine whether differences in basic cognitive profiles moderate intervention response. The acceptability and feasibility of STRIPES and treatment moderators will also be examined.DiscussionThis study will generate knowledge about the effectiveness and implementability of STRIPES, which will inform dissemination efforts in the future. A peer-delivered high school intervention for organization, time management, and planning skills can provide accessible and feasible treatment targeting declines in academic motivation, grades, and attendance during the ninth-grade year.Trial registrationThis study is registered on OSF Registries (10.17605/OSF.IO/Q8V6S).

Feasibility and acceptability of peer-delivered interventions using mHealth for PrEP services among adolescent girls and young women in DREAMS program in Botswana

ABSTRACT Background Adolescent girls and young women accounted for 25% of all new HIV infections despite representing only 10% of the population in Sub Saharan Africa. PEPFAR has launched the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) initiative, a comprehensive HIV prevention program including PrEP services. Among adolescent girls and young women, PrEP adherence is currently sub-optimal. Tailored strategies for adolescent girls and young women to improve access and use of PrEP delivery are urgently needed to maximise its potential. Recommended interventions include peer-delivered interventions using mobile technology. However, data on the feasibility and acceptability of this approach is limited for SSA. Objectives We assessed the feasibility and perceived acceptability of providing mHealth peer-delivered interventions to support PrEP services among adolescent girls and young women in Botswana. Methods This cross-sectional study included HIV-negative women aged 18–24 years old seeking health services at DREAMS-supported facilities. Participants completed a survey assessing the feasibility and perceived acceptability of the mHealth peer-delivered interventions, which included the Acceptability of Intervention Measure (AIM). Descriptive analyses were performed. Results A total of 131 participated in the study. Overall, 89% owned a mobile phone (feasibility). There was no difference in cell phone ownership between participants from rural and urban settings. Among participants, 85% reported interest in participating in a mHealth peer-delivered intervention if it was available to them. Regarding perceived acceptability for mHealthpeer support groups for PrEP, the average score on the AIM was 3.8 out of 5 (SD = 0.8). Conclusion mHealthpeer-delivered interventions appear to be feasible and perceived acceptable among adolescent girls and young women in Botswana. This modality should be incorporated into PEPFAR’s programmatic toolkit of implementation strategies to improve PrEP services.

Peer Activate: A Feasibility Trial of a Peer-Delivered Intervention to Decrease Disparities in Substance Use, Depression, and Linkage to Substance Use Treatment.

Although effective evidence-based interventions (EBIs) exist, racial/ethnic minority individuals with lower income are less likely to have access to these interventions and may experience greater stigma in the health care system, resulting in disproportionate rates of morbidity and mortality. Peer recovery specialists (PRSs) may be uniquely suited to address barriers faced by those from impoverished areas; however, peers have not traditionally been trained in implementing EBIs. The current open-label trial (N = 8) was performed to evaluate implementation and preliminary effectiveness of an adapted EBI supporting recovery, linkage to treatment, and reduced depression. Results suggest the intervention was feasible, acceptable, and appropriate for linking individuals from a community setting to substance use treatment and could be delivered with fidelity by a peer interventionist. Participants who completed the intervention demonstrated clinically reliable decreases in substance use and depressive symptoms. Findings provide initial support for PRS dissemination of EBIs to increase linkage to care and support recovery in traditionally underserved populations. [Journal of Psychosocial Nursing and Mental Health Services, 61(11), 23-31.].

0198 Effects of a 1-hour nightly weeklong sleep extension pilot study in undergraduates on health

Abstract Introduction Sleep restriction impairs health, but less is known about the potential health benefits of extending sleep in undergraduate students with habitual short sleep. This study examined the effects of a 1-week, 1-hour per night sleep extension on cardiometabolic health, hydration status, sedentary behavior, and physical activity in undergraduate students. Methods Twelve healthy undergraduate students (83% female; mean±SD age 20.2±1.5; range 18-23 years) obtaining fewer than 7 hours of average nightly sleep completed a two-week study. The first week consisted of sleeping typically ("Habitual"), followed by a peer-delivered intervention to extend time in bed by ≥1 hour/night during the second week ("Extension"). Sleep and physical activity actigraphy were collected throughout. Following each week, participants completed in-person cardiometabolic assessments, including a standardized meal response procedure and blood pressure measurement. Blood samples for measurement of glucose and insulin were collected before, during, and following a standardized breakfast. Urine samples yielded markers of hydration (specific gravity and osmolality). Mixed-effects regression models with random intercepts for individuals compared outcomes after the Extension week to Habitual outcomes. Results Compared to Habitual sleep, average sleep duration across the Extension week increased (b±SEM, +42.6±.3 minutes; p=.005). After the breakfast meal, glucose area under the curve (AUC; −26.5±10.2 mg/dL*h; p=.025) and time to return to baseline levels (−83.0±46.4 minutes; p=.031) decreased following Extension. There was no change in insulin AUC. Systolic blood pressure decreased (−6.6±2.8 mmHg; p=.037) after Extension. Average time spent in sedentary behavior (−44.3±15.7 minutes; p=.018) and percentage of wake spent in moderate-to-vigorous physical activity (−1%±.4%; p=.030) decreased across the Extension week. Participants who increased average sleep duration ≥15 minutes (n=9) were better hydrated according to urine osmolality (−187.0±68.4 mOsm/kg; p=.026) and specific gravity (−.01±.002 g/mL; p=.012) and had lowered odds of dehydration according to urine osmolality (≥800 mOsm/kg; −67%; OR=.03; p=.035). Conclusion This pilot study provided evidence that sleep extension may improve cardiometabolic health and hydration and reduce both sedentary behavior and moderate-to-vigorous physical activity. Future research in randomized controlled trials should examine if such findings extrapolate to larger samples and older populations. Support (if any) CRC/CTSI: UL1-TR002014; pilot grant to AMC from the Department of Biobehavioral Health, Pennsylvania State University

“Sometimes you have to take the person and show them how”: adapting behavioral activation for peer recovery specialist-delivery to improve methadone treatment retention

BackgroundDespite efficacy of medication for opioid use disorder, low-income, ethno-racial minoritized populations often experience poor opioid use disorder treatment outcomes. Peer recovery specialists, individuals with lived experience of substance use and recovery, are well-positioned to engage hard-to-reach patients in treatment for opioid use disorder. Traditionally, peer recovery specialists have focused on bridging to care rather than delivering interventions. This study builds on research in other low-resource contexts that has explored peer delivery of evidence-based interventions, such as behavioral activation, to expand access to care.MethodsWe sought feedback on the feasibility and acceptability of a peer recovery specialist-delivered behavioral activation intervention supporting retention in methadone treatment by increasing positive reinforcement. We recruited patients and staff at a community-based methadone treatment center and peer recovery specialist working across Baltimore City, Maryland, USA. Semi-structured interviews and focus groups inquired about the feasibility and acceptability of behavioral activation, recommendations for adaptation, and acceptability of working with a peer alongside methadone treatment.ResultsParticipants (N = 32) shared that peer recovery specialist-delivered behavioral activation could be feasible and acceptable with adaptations. They described common challenges associated with unstructured time, for which behavioral activation could be particularly relevant. Participants provided examples of how a peer-delivered intervention could fit well in the context of methadone treatment, emphasizing the importance of flexibility and specific peer qualities.ConclusionsImproving medication for opioid use disorder outcomes is a national priority that must be met with cost-effective, sustainable strategies to support individuals in treatment. Findings will guide adaptation of a peer recovery specialist-delivered behavioral activation intervention to improve methadone treatment retention for underserved, ethno-racial minoritized individuals living with opioid use disorder.

A peer-delivered psychosocial support intervention improves disease acceptance and quality of life in patients with rare diseases – A randomized controlled trial

A peer-delivered psychosocial support intervention improves disease acceptance and quality of life in patients with rare diseases – A randomized controlled trial

Randomized Controlled Trial of Healthy Divas: A Gender-Affirming, Peer-Delivered Intervention to Improve HIV Care Engagement Among Transgender Women Living With HIV.

Background:Transgender women are disproportionately affected by HIV and are less likely to be optimally engaged in care than other groups because of psychosocial challenges. With community collaboration, we developed Healthy Divas, an individual-level intervention to increase healthcare empowerment and gender affirmation to improve engagement in HIV care. Healthy Divas comprises 6 peer-led individual sessions and one group workshop facilitated by a healthcare provider with expertise in HIV care and transgender health.Setting/Methods:To test the intervention's efficacy, we conducted a randomized controlled clinical trial in San Francisco and Los Angeles among transgender women living with HIV; control was no intervention. Transgender field staff conducted recruitment. Assessments occurred at baseline and 3, 6, 9, and 12 months postrandomization. The primary outcome was engagement in HIV care, defined as the sum of (1) self-reported HIV care provider visit, past 6 months, (2) knowledge of most recent CD4 count, (3) self-reported antiretroviral therapy adherence ≥90%, and (4) self-reported antiretroviral therapy adherence ≥80%.Results:We enrolled 278 participants; almost half (46%) were African American/Black and one-third (33%) were Hispanic/Latina. At 6 months, participants in the intervention arm had over twice the odds of being in a higher HIV care engagement category than those in the control arm (aOR = 2.17; 95% CI: 1.06 to 4.45; P = 0.04); there were no significant study arm differences in the outcome at the other time points.Conclusions:This trial demonstrates the short-term efficacy of an urgently needed behavioral intervention to improve engagement in HIV care among transgender women living with HIV; ongoing intervention may be needed to maintain positive impact over time.Trial Registration:Clinicaltrials.gov identifier: NCT03081559.

Understanding how social support influences peer-delivered HIV prevention interventions among Ugandan female sex workers: a case study from HIV self-testing

BackgroundFemale sex workers (FSWs) have tightly connected peer networks and remain at high risk of HIV acquisition. Peer delivery of HIV prevention interventions, such as HIV self-testing (HIVST), is a recommended implementation strategy for increasing intervention uptake and continuation among FSWs. We analyzed qualitative data from a peer-delivered HIVST intervention among FSWs in urban Uganda to understand the ways social support within this peer network can motivate or discourage the uptake of peer-delivered HIVST.MethodsBetween February and April 2017, we conducted in-depth interviews (IDIs) with FSWs (n = 30) and focus group discussions (FGDs) with FSW peer educators (PEs, n = 5) finishing participation in a four-month randomized implementation trial testing models of peer-delivered HIVST in Kampala. FSW participants were ≥ 18 years old, self-reported exchanging sex for money or goods (past month) and had not recently tested for HIV (past 3 months). FSW PEs either directly distributed HIVST kits to participants or provided coupons exchangeable for HIVST kits from specified healthcare facilities. In the IDIs and FGDs, we asked participants to share their experiences receiving or delivering peer-delivered HIVST, respectively. Using a hybrid deductive and inductive coding approach, we arranged findings along the dimensions of an established social support theory: informational, instrumental, and emotional support.ResultsThe median age of participants was 30 years (IQR: 27–33) and PEs was 33 years (IQR: 29–37). We found that social support within FSW peer networks both motivated and discouraged uptake of peer-delivered HIVST. For example, sharing positive HIVST experiences (informational support), directly delivering HIVST kits (instrumental support), and encouraging linkage to care (emotional support) motivated HIVST uptake among FSWs. Conversely, the spread of misinformation (informational support), limited HIVST kit availability fostering mistrust of PEs (instrumental support), and fear of social exclusion following HIV status disclosure (emotional support) discouraged HIVST uptake among FSWs.ConclusionsIn Uganda, social support (e.g., informational, instrumental, and emotional support) among FSW peers can work in ways that both motivate and discourage peer-delivered intervention uptake. Future FSW peer-delivered HIV prevention interventions should be designed around the dimensions of social support within FSW peer networks to maximize initial and repeat intervention delivery and uptake.

Implementation of a campus-based and peer-delivered HIV self-testing intervention to improve the uptake of HIV testing services among university students in Zimbabwe: the SAYS initiative

BackgroundThe uptake of HIV testing services among adolescents and young adults in Zimbabwe is low due to stigma associated with the risk of mental and social harm. The WHO recommends HIV self-testing (HIVST) as an innovative approach to improve access to HIV testing for this hard-to-reach populations. This study describes the development and implementation of a coordinated multifaceted and multidisciplinary campus-based approach to improve the uptake of HIV testing among university students in Zimbabwe.MethodsWe utilized both quantitative and qualitative methods guided by the Exploration, Preparation, Implementation, and Sustainment Framework. A formative survey, in-depth interviews, and a scoping review were conducted as part of the situation analysis. Implementers (peer educators and health workers) were trained and community dialogue sessions were conducted to ascertain the determinants (enablers and barriers) influencing both the inner and outer contexts. Self-test kits were disbursed over 6 months before a summative evaluation survey was conducted. Qualitative data were analyzed thematically while the chi-squared test was used to analyze quantitative data.ResultsThe formative evaluation showed that 66% of students intended to test and 44% of the enrolled students collected HIVST test kits. Giving comprehensive and tailored information about the intervention was imperative to dispel the initial skepticism among students. Youth-friendly and language-specific packaging of program materials accommodated the students. Despite the high acceptability of the HIVST intervention, post-test services were poorly utilized due to the small and isolated nature of the university community. Implementers recommended that the students seek post-test services off-site to ensure that those with reactive results are linked to treatment and care.ConclusionsPeer-delivered HIVST using trained personnel was acceptable among adolescents and young adults offered the intervention at a campus setting. HIVST could increase the uptake of HIV testing for this population given the stigma associated with facility-based HTS and the need for routine HIV testing for this age group who may not otherwise test. An off-site post-test counseling option is likely to improve the implementation of a campus-based HIVST and close the linkage to treatment and care gap.

Assessing the feasibility, acceptability and accessibility of a peer-delivered intervention to reduce harm and improve the well-being of people who experience homelessness with problem substance use: the SHARPS study

BackgroundFor people experiencing homelessness and problem substance use, access to appropriate services can be challenging. There is evidence that the development of trusting relationships with non-judgemental staff can facilitate service engagement. Peer-delivered approaches show particular promise, but the evidence base is still developing.MethodsThe study used mixed methods to assess the feasibility, acceptability and accessibility of a peer-delivered, relational intervention to reduce harms and improve health/well-being, quality of life and social functioning, for people experiencing homelessness and problem substance use. Four Peer Navigators were employed to support individuals (n = 68 total, intervention participants). They were based in outreach services and hostels in Scotland and England. Qualitative interviews were conducted with intervention participants, Peer Navigators and staff in services, and observations were conducted in all settings. Quantitative outcomes relating to participants’ substance use, physical and mental health, and quality of the Peer Navigator relationship, were measured via a ‘holistic health check’ with six questionnaires completed at two time-points.ResultsThe intervention was found to be acceptable to, and feasible and accessible for, participants, Peer Navigators, and service staff. Participants reported improvements to service engagement, and feeling more equipped to access services independently. The lived experience of the Peer Navigators was highlighted as particularly helpful, enabling trusting, authentic, and meaningful relationships to be developed. Some challenges were experienced in relation to the ‘fit’ of the intervention within some settings. Among participants there were reductions in drug use and risky injecting practices. There were increases in the number of participants receiving opioid substitution therapy. Overall, the intervention was positively received, with collective recognition that the intervention was unique and highly valuable. While most of the measures chosen for the holistic health check were found to be suitable for this population, they should be streamlined to avoid duplication and participant burden.ConclusionsThe study established that a peer-delivered, relational harm reduction intervention is acceptable to, and feasible and accessible for, people experiencing homelessness and problem substance use. While the study was not outcomes-focused, participants did experience a range of positive outcomes. A full randomised controlled trial is now required to assess intervention effectiveness.Trial registrationStudy registered with ISRCTN: 15900054.

A peer-delivered intervention to reduce harm and improve the well-being of homeless people with problem substance use: the SHARPS feasibility mixed-methods study.

For people experiencing homelessness and problem substance use, access to appropriate services can be challenging. There is evidence that development of trusting relationships with non-judgemental staff can facilitate service engagement. Peer-delivered approaches show particular promise, but the evidence base is still developing. This study tested the feasibility and acceptability of a peer-delivered intervention, through 'Peer Navigators', to support people who are homeless with problem substance use to address a range of health and social issues. The study objectives were to design and implement a peer-delivered, relational intervention to reduce harms and improve health/well-being, quality of life and social functioning for people experiencing homelessness and problem substance use, and to conduct a concurrent process evaluation to inform a future randomised controlled trial. A mixed-methods feasibility study with concurrent process evaluation was conducted, involving qualitative interviews [staff interviews (one time point), n = 12; Peer Navigator interviews (three or four time points), n = 15; intervention participant interviews: first time point, n = 24, and second time point, n = 10], observations and quantitative outcome measures. The intervention was delivered in three outreach services for people who are homeless in Scotland, and three Salvation Army hostels in England; there were two standard care settings: an outreach service in Scotland and a hostel in England. Participants were people experiencing homelessness and problem substance use (n = 68) (intervention). This was a peer-delivered, relational intervention drawing on principles of psychologically informed environments, with Peer Navigators providing practical and emotional support. Outcomes relating to participants' substance use, participants' physical and mental health needs, and the quality of Peer Navigator relationships were measured via a 'holistic health check', with six questionnaires completed at two time points: a specially created sociodemographic, health and housing status questionnaire; the Patient Health Questionnaire-9 items plus the Generalised Anxiety Disorder-7; the Maudsley Addiction Profile; the Substance Use Recovery Evaluator; the RAND Corporation Short Form survey-36 items; and the Consultation and Relational Empathy Measure. The Supporting Harm Reduction through Peer Support (SHARPS) study was found to be acceptable to, and feasible for, intervention participants, staff and Peer Navigators. Among participants, there was reduced drug use and an increase in the number of prescriptions for opioid substitution therapy. There were reductions in risky injecting practice and risky sexual behaviour. Participants reported improvements to service engagement and felt more equipped to access services on their own. The lived experience of the Peer Navigators was highlighted as particularly helpful, enabling the development of trusting, authentic and meaningful relationships. The relationship with the Peer Navigator was measured as excellent at baseline and follow-up. Some challenges were experienced in relation to the 'fit' of the intervention within some settings and will inform future studies. Some participants did not complete the outcome measures, or did not complete both sets, meaning that we do not have baseline and/or follow-up data for all. The standard care data sample sizes make comparison between settings limited. A randomised controlled trial is recommended to assess the effectiveness of the Peer Navigator intervention. A definitive cluster randomised controlled trial should particularly consider setting selection, outcomes and quantitative data collection instruments. This trial is registered as ISRCTN15900054. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 14. See the NIHR Journals Library website for further project information.

Peer providers and linkage with buprenorphine care after hospitalization: A retrospective cohort study

Background: People with opioid use disorder (OUD) are increasingly started on buprenorphine in the hospital, yet many patients do not attend outpatient buprenorphine care after discharge. Peer providers, people in recovery themselves, are a growing part of addiction care. We examine whether patients who received a low-intensity, peer-delivered intervention during hospitalization had a greater rate of linking with outpatient buprenorphine care relative to those not seen by a peer. Methods: This was a retrospective cohort study of adults with OUD who were started on buprenorphine during hospitalization. The primary outcome was receipt of a buprenorphine prescription within 30 days of discharge. Secondary outcomes included attendance at a follow-up visit with a buprenorphine provider within 30 days and hospital readmission within 90 days. Modified Poisson regression analyses tested for differences in the rate ratios (RR) of each binary outcome for patients who were versus were not seen by a peer provider. Peer notes in the electronic health record were reviewed to characterize peer activities. Results: 111 patients met the study inclusion criteria, 31.5% of whom saw a peer provider. 55.0% received a buprenorphine prescription within 30 days of hospital discharge. Patients with versus without peer provider encounters did not significantly differ in the rates of receiving a buprenorphine prescription (RR = 1.06, 95% CI: 0.74-1.51), hospital readmission (RR = 1.45, 95% CI: 0.80-2.64), or attendance at a buprenorphine follow-up visit (RR = 1.03, 95% CI: 0.68-1.57). Peers most often listened to or shared experiences with patients (68.6% of encounters) and helped facilitate medical care (60.0% of encounters). Conclusions: There were no differences in multiple measures of buprenorphine follow-up between patients who received this low-intensity peer intervention and those who did not. There is need to investigate what elements of peer provider programs contribute to patient outcomes and what outcomes should be assessed when evaluating peer programs.

Patient and provider perceptions of a peer-delivered intervention ('Khanya') to improve anti-retroviral adherence and substance use in South Africa: a mixed methods analysis.

Despite a high prevalence of problematic substance use among people living with HIV in South Africa, there remains limited access to substance use services within the HIV care system. To address this gap, our team previously developed and adapted a six-session, peer-delivered problem-solving and behavioral activation-based intervention (Khanya) to improve HIV medication adherence and reduce substance use in Cape Town. This study evaluated patient and provider perspectives on the intervention to inform implementation and future adaptation. Following intervention completion, we conducted semi-structured individual interviews with patients (n = 23) and providers (n = 9) to understand perspectives on the feasibility, acceptability, and appropriateness of Khanya and its implementation by a peer. Patients also quantitatively ranked the usefulness of individual intervention components (problem solving for medication adherence 'Life-Steps', behavioral activation, mindfulness training, and relapse prevention) at post-treatment and six months follow-up, which we triangulated with qualitative feedback to examine convergence and divergence across methods. Patients and providers reported high overall acceptability, feasibility, and appropriateness of Khanya, although there were several feasibility challenges. Mindfulness and Life-Steps were identified as particularly acceptable, feasible, and appropriate components by patients across methods, whereas relapse prevention strategies were less salient. Behavioral activation results were less consistent across methods. Findings underscore the importance of examining patients' perspectives on specific intervention components within intervention packages. While mindfulness training and peer delivery models were positively perceived by consumers, they are rarely used within task-shared behavioral interventions in low- and middle-income countries.

Novel Strategies to Reach and Engage Older Veterans During COVID-19

The COVID-19 pandemic and associated public health measures to prevent its spread have important implications for the health and wellbeing of older Veterans. Prior to the pandemic, social isolation was already recognized as a risk for older adults, contributing to increased risk of depression, physical inactivity, and mortality. Stay-at-home orders, social distancing, and transitions to new ways of delivering care have meant that many of the ways in which older Veterans connect with VA and others have changed. Older Veterans and Veterans with serious mental illness (SMI) are especially vulnerable to experience negative impacts from social isolation and loneliness. This symposium will present on four novel and adapted strategies for engaging with older Veterans during the COVID-19 pandemic and beyond: 1) VA Connection Plans, a whole health intervention to promote social connections for older Veterans with and without SMI (Peeples); 2) telehealth adaptations to PEER, an in-person, peer-delivered exercise intervention for older Veterans with SMI (Muralidharan); 3) VA Compassionate Contact Corps, a VA Voluntary Service program to connect older Veterans with friendly volunteers via telephone (Sullivan); and 4) group telehealth interventions to foster social connection among older Veterans and their families (Weiskittle). Kim Van Orden, geropsychologist and director of the Hope Lab (Helping Older People Engage) at the University of Rochester Medical Center, will serve as discussant.

Peer-delivered services and peer support reaching people with schizophrenia: A scoping review

Peers with shared lived experience may help people with schizophrenia (PWS) recover in many ways, such as by assisting them to cope with debilitating symptoms, address practical challenges of living, combat stigma, and lessen social isolation. Despite their expansion in practice, peer-delivered services are not yet considered to be evidence-based practice for schizophrenia. This is due in part to the diversity of intervention components across programs, leading to uncertainty about just what these services entail. A focused examination of strategies and intended outcomes will facilitate more effective service design and delivery. To this end, this scoping review systematically examined the published literature describing peer-delivered services reaching PWS. The 22 studies reviewed described 20 unique interventions, representing significant diversity in formats and components, including those focused on psychological coping and practical skills, such as for independent living. Seven of nine studies measuring at least one key outcome (acute care utilization, patient functioning, positive or negative symptoms) found significant effects favoring peer-delivered intervention. Three of four studies measuring negative symptoms reported a reduction, notable considering these are often difficult to change. Results suggest areas for improvement, including a more thorough examination of program components and tailoring to the specific needs of PWS.

A medical peer-delivered intervention comprising brief motivational interviewing via instant-messaging interaction to reduce drug misuse among youth in Hong Kong: A protocol for a randomised controlled trial

AimsYouth are frequently exposed to drugs, and most youth who misuse drugs are reluctant to seek help from services due to the worry of others being judgmental, lacking expertise, exposing their personal information, or informing their parents. Considering these concerns, we propose to evaluate the effectiveness of a medical peer-delivered intervention comprising brief motivational interviewing via instant-messaging interaction in reducing drug misuse among youth in Hong Kong.MethodsA two-group single-blind, randomised controlled trial will be conducted. Multiple approaches, including online and face-to-face methods, will be used to recruit the participants. The participants, aged 25 years or younger and reporting any drugs that they have taken within the past 30 days, will be recruited and randomised to receive either brief motivational interviewing via interactive instant-messaging (the intervention) or general health text-messages (comparator). The primary outcome will be the change in the participants’ reductions in self-reported drug consumption at 12 months compared to that at baseline. The secondary outcomes will be the changes in the drug-abusing participants’ reductions in self-reported drug consumption at 6 months, the changes in the drug-quitting participants’ 6- and 12-month contemplation stages and relapse risk compared to that at baseline, 30 days’ self-reported drug abstinence at 6 and 12 months, and the treatment needs and motivation at 6 and 12 months compared to that at baseline. The effectiveness of the proposed intervention will be examined with adjusted regression models, with adjustment for baseline characteristics and the use of an intention-to‐treat approach.DiscussionThis proposed study will be the first randomised controlled trial to assess the effectiveness of a medical peer-delivered interactive intervention to reduce drug misuse among youth in Hong Kong. The proposed intervention has the potential to increase the help-seeking behaviour and intention to quit among youth who misuse drugs. As a result, more youth misusing drugs may be helped to abstain from drugs. This proposed study will inform decisions on whether it is worthwhile to invest resources in large-scale implementation of such an intervention.

Efficacy of a Brief, Peer-Delivered Self-management Intervention for Patients With Rare Chronic Diseases

Patients coping with rare diseases need psychosocial support. To evaluate the efficacy of a brief, transdiagnostic, peer-delivered intervention for patients with rare diseases in addition to care as usual (CAU) compared with CAU only. In this 2-group randomized clinical trial conducted from October 5, 2017, to July 12, 2019, patients were recruited via specialized clinics and patient organizations across Germany and participated from home. The study included consecutive adult patients with neurofibromatosis type 1, Marfan syndrome, primary sclerosing cholangitis, and pulmonary arterial hypertension who have limited functionality because of the disease. Exclusion criteria were a life-threatening health status and ongoing psychotherapeutic treatment. Of 143 patients screened for eligibility with a semistructured telephone interview, 54 were excluded, and 89 were randomized: 45 patients were randomly allocated to the peer-delivered intervention group, and 44 to the control group; 87 patients (98%) completed the 6-month follow-up assessment. The analysis was performed using an intention-to-treat principle. Data cleansing and analysis were conducted between April 25, 2019, and February 13, 2020. The 6-week intervention consisted of a self-help book and telephone-based peer counseling in addition to CAU. The control group received CAU alone. Peer counselors received training, structured consultation guidelines, and supervision. The primary outcome was acceptance of the disease as assessed using the Illness Cognition Questionnaire (ICQ; mean sum scores range from 0 to 18, with higher values representing more acceptance) 6 months after the intervention. Secondary outcomes included self-reported coping strategies (Health Education Impact Questionnaire), illness cognition (ICQ and Illness Perception Questionnaire), depression severity (Patient Health Questionnaire 9-item depression scale), anxiety severity (Generalized Anxiety Disorder Scale), quality of life (12-Item Short-Form Health Survey), and social support (Social Support Questionnaire). Outcomes were assessed before the intervention, after the intervention, and at a 6-month follow-up. The mean (SD) age of the 89 participating patients was 46.3 (14.9) years; 59 (66%) were women. There were no group differences regarding baseline variables. All patients allocated to the intervention group completed the intervention. Six months after the intervention, but not directly after completing the program, the intervention group had significantly higher rates of acceptance (ICQ) of the disease (primary outcome) compared with the CAU group. Mean (SD) baseline ICQ scores were 9.61 (3.79) in the control group and 9.86 (3.40) in the intervention group. Mean (SE) ICQ scores at 6 months were 10.32 (0.42) for the control group and 11.79 (0.42) for the intervention group, with a significant mean difference of -1.47 (95% CI, -2.63 to -0.31; P = .01). Several secondary outcomes, including different coping strategies, social support, and mental quality of life, were significantly higher after the intervention compared with the control group. In this randomized clinical trial, a self-help and peer counseling intervention improved patients' acceptance of their rare chronic diseases. Self-management and peer support can efficiently address the unique care needs of patients with rare diseases. isrctn.org Identifier: ISRCTN13738704.

A consultation with feedback approach to supporting fidelity to a peer-delivered intervention for posttraumatic stress disorder.

Despite promising findings regarding the safety, fidelity, and effectiveness of peer-delivered behavioral health programs, there are training-related challenges to the integration of peers on health care teams. Specifically, there is a need to understand the elements of training and consultation that may be unique to peer-delivered interventions. As part of a pilot effectiveness-implementation study of an abbreviated version of Skills Training in Affective and Interpersonal Regulation (STAIR) for posttraumatic stress disorder (PTSD), we conducted a mixed-methods process evaluation utilizing multiple data sources (questionnaires and field notes) to characterize our approach to consultation and explore relations between fidelity, treatment outcome, and client satisfaction. Peer interventionists exhibited high fidelity, defined by adherence (M = 93.7%, SD = 12.3%) and competence (M = 3.7 "competent," SD = 0.5). Adherence, β = .69, t(1) = 3.69, p < .01, and competence, β = .585, t(1) = 2.88, p < .05, were each associated with trial participant's satisfaction, but not associated with clinical outcomes. Our synthesis of fidelity-monitoring data and consultation field notes suggests that peer interventionists possess strengths in interpersonal effectiveness, such as rapport building, empathy, and appropriate self-disclosure. Peer interventionists evidenced minor challenges with key features of directive approaches, such as pacing, time efficiency, and providing strong theoretical rationale for homework and tracking. Due to promise of peers in expanding the behavioral health workforce and engaging individuals otherwise missed by the medical model, the current study aimed to characterize unique aspects of training and consultation. We found peer interventionists demonstrated high fidelity, supported through dynamic training and consultation with feedback. Research is needed to examine the impact of consultation approach on implementation and treatment outcomes. Peers-paraprofessionals who use their lived experiences to engage and support the populations they serve-have been increasingly integrated into health care settings in the United States. Training peers to deliver interventions may provide cost savings by way of improving efficient utilization of professional services. Despite promising findings in regard to safety, intervention fidelity, and effectiveness of peer delivery, there are important challenges that need to be addressed if peers are to be more broadly integrated into the health care system as interventionists. These include challenges associated with highly variable training, inadequate supervision, and poor delineation of peer's roles within the broader spectrum of care. Thus, there is a need to understand the unique components of training and consultation for peers. We report key findings from an evaluation of a pilot study of an abbreviated version of Skills Training in Affective and Interpersonal Regulation (STAIR) for posttraumatic stress disorder (PTSD), adapted for peer delivery. We characterize our approach to consultation with feedback and explore relations between fidelity, treatment outcome, and client satisfaction. Our study extends the small yet growing literature on training and consultation approaches to support fidelity (adherence and competence) among peer interventionists. Organizations hoping to integrate peers on health care teams could utilize our fidelity-monitoring approach to set benchmarks to ensure peer-delivered interventions are safe and effective.

Older Adult Peer Specialists’ Role in Reducing Loneliness Among People With Mental Health Conditions

PeerTECH is a peer-delivered and technology-support integrated medical and psychiatric self-management intervention developed by peers. A pre/post trial by our group has shown PeerTECH is associated with statistically significant improvements in self-efficacy for managing chronic disease and psychiatric self-management skills. This presentation will discuss the feasibility and potential effectiveness of using ecological momentary assessments (EMA) with older adults with mental health conditions to allow us to recognize early signs of loneliness and intervene as early as possible in real-world settings. EMA involves repeated sampling of an individual’s behaviors and experiences in real time, real-world environments on the smartphone application. Then, we will discuss the main and interactive effects of loneliness and factors linked to mortality. In conclusion, we will discuss potential effectiveness of PeerTECH with older adults with SMI.