Another limitation is that we did not collect information to ascertain whether cross-contamination was an issue. Finally, outcome data were collected based on self-report surveys and potential self-report biases cannot be ruled out. However, the research team took every measure to ensure that students had a private environment to complete the questionnaire, and provided formal assurances of confidentiality and emphasized the use of unique identifiers that would prevent others outside of the research team from linking surveys to any specific individual.
In spite of these limitations, as a result of their participation in Teen PEP peer educators included in this study developed the confidence necessary to avoid high-risk sexual behaviors.
Further, the program provided peer educators with information that informed their sexual decisions and increased their intentions to communicate about sexual health issues and set appropriate boundaries with potential partners. Sustaining Teen PEPs may allow for persistence of these outcomes and lead to reductions in sexual risk-taking behaviors; this remains to be evaluated in future research. Investigators should also evaluate these factors over time to determine the degree to which the potential benefits of Teen PEP are lasting and generalizable.
A special note of appreciation to the Teen PEP schools who participated in this evaluation, which, without their enthusiastic support, none of this would have been possible. National Center for Biotechnology Information , U.
Health Educ Res. Published online Jan Howard , 1 and C. Perotte 1, 2. Author information Article notes Copyright and License information Disclaimer. E-mail: ude. Received Apr 30; Accepted Dec Published by Oxford University Press. All rights reserved. For permissions, please email: journals. This article has been cited by other articles in PMC.
Introduction Adolescents are more concerned about sex and sexual health than any other health issue in their lives [ 1 ]. Methods Study design This study employed a quasi-experimental, matched comparison group design and was conducted from May to May Open in a separate window. Intervention Selected peer educators intervention students were enrolled into Teen PEP and participated in an initial 3-day, overnight retreat between May and September Measures Participants completed confidential paper and pencil surveys at baseline and month follow-up.
Demographic variables i Gender male, female , ii age continuous and iii race Caucasian, African American, Asian and Other. Knowledge Using a item index, we measured knowledge of sexual health issues related to how to prevent a pregnancy, prevention of STIs and HIV. Clarity of values around sexual behavior The degree to which participants are unclear about their personal rules and values regarding their sexual behavior was measured via five items on a four-point Likert scale where 1 indicated strongly disagree and 4 indicated strongly agree [ 26 ].
Sexual health information Five items assessed the degree to which participants were learning relevant sexual health information in school. Results Study population At the start of the program, participants were on average 16 years of age [standard deviation SD 0.
Table I. Bivariate and multiple regression analyses Analyses to test for equivalency of the baseline characteristics identified three significant differences between the Teen PEP i. Table II. Table IV. Discussion The results of this Teen PEP evaluation study highlight and affirm the role school-based peer leadership programs may play in efforts to promote the development of healthy sexual futures for adolescents. Conflict of interest statement None declared.
References 1. Klein JD. Adolescent pregnancy: current trends and issues. Youth risk behavior surveillance—United States, The power of peer health education. J Am Coll Health. Miburn K. A critical review of peer education with young people with special reference to sexual health. Mason H. Peer Education: Promoting Healthy Behaviors. Washington, DC: Advocates for Youth; J Pediatr Nurs. Baldwin J.
Peer Facilitator Q. Fennell R. A review of evaluations of peer education programs. Over the past few years, it has been increasingly recognized that the unique needs of adolescents, and young people are not adequately addressed within standard pediatric or adult HIV service delivery models. Data from research, surveillance, and program monitoring have shown that HIV-infected adolescents and young people have lower rates of knowing their HIV status, linkage to care and treatment, retention, and viral suppression [ 2 ].
To improve these poor outcomes, there has been an effort in many countries with large HIV burdens to prioritize and scale up new adolescent and youth-targeted models of service delivery. For adolescents specifically, peers can be a unique and powerful source of empathic support. Social acceptance may be more critical for this age group than any other [ 4 ], yet many AYPLHIV experience stigma and peer violence, leading to depression, anxiety, and suicidality [ 5 ]. In this context, peer support has a protective effect, buffering the effects of stigma [ 6 ] and positively influencing behavior.
These egalitarian peer relationships promote health and well-being while providing a supportive complement to traditional health system cadres. While there are significant variations in implementation approaches to peer support, what programs tend to have in common is that they regard and position AYPLHIV not merely as vulnerable and passive recipients of care, but rather a potent social asset that should be engaged, harnessed, and enabled to form a critical part of the solution [ 7 ].
Observed bottlenecks related to insufficient financing, planning, coordination, and evidence impede national scale-up, and there remains a need to identify the most effective and sustainable programmatic approaches for the region. This paper highlights examples of peer support models in sub-saharan Africa, and examines determinants of successful implementation, outcomes and scale-up, including policy and programmatic implications. Peer support can be provided in a variety of ways.
While robust reach and coverage data are not readily available, it appears that many health facilities in low- and middle-income countries within sub-Saharan Africa are implementing peer support for AYPLHIV.
While peer support has not been consistently effective for adolescent and youth HIV prevention [ 9 ] or sexual health education [ 10 ], some peer support programs have demonstrated impact on improving health-seeking behavior and HIV treatment outcomes for AYPLHIV, such as linkage, adherence to antiretrovial therapy ART , retention in care, and viral suppression.
However, observations from implementation have shown challenges in understanding the effects of peer support on these outcomes due to the heterogeneity of peer support terminology and variety of implementation approaches.
Peer support can include various peer supporter cadres and roles, individual and group support models, in person and virtual support, and a variety of training, supervision and approaches to institutionalization. Furthermore, observation shows that peer support is rarely implemented as a standalone intervention, but typically provided as one component of a multifaceted package of youth-focused services, such as training health workers on AFHS and youthfriendly scheduling, each of which may influence HIV treatment outcomes.
Distilling the specific impact of each service element is thus difficult, and there is a need for more investigation on the component of peer support. There are few documented descriptions of peer support or their effectiveness, but there are several examples primarily from large facilities and centers of excellence. Most information on outcomes has come from program reports, evaluations, and conference abstracts with very few described in peer reviewed literature. A recent study describing the Zvandiri model in Zimbabwe also indicated that implementing a peer support model improved linkage to ART.
The model engages a cadre of 18—year-olds living with HIV, known as community adolescent treatment supporters CATS , to deliver adherence and psychosocial support through weekly home visits, monthly peer support groups, and linkage to other services [ 13 ]. Zvandiri also found that in addition to supporting linkage, CATS were also effective at improving retention and adherence.
Young people receiving the CATS intervention were 3. A follow-up trial of the model is currently underway, evaluating spacing of monthly home visits and the addition of a weekly, individualized short message service SMS [ 14 ]. Few examples of peer support report on viral load suppression VLS as an outcome.
OTZ engages peer supporters known as OTZ Champions to empower young people to take charge of their own health and achieve a treatment goal of three zeroes: zero missed appointments, zero missed drugs, and zero viral load. Adolescents and young people have reported that peer support plays a significant role in improving adherence [ 22 , 23 ], retention [ 24 ], and reducing viral load [ 23 ]. There is limited discussion highlighting the positive impact of peer support on reducing perceived stigma [ 16 ] and improving psychosocial well-being [ 13 ], and further investigation is needed in these areas.
In addition to in-person peer support, there has been growth in virtual peer support using SMS, telephone calls, WhatsApp, and other social media [ 26 ]. With the rapid increase in mobile phone availability in sub-Saharan Africa, virtual support has potential to assist AYPLHIV to access regular support and remain connected between face-to-face meetings without significant effort or cost.
One example from South Africa [ 27 ] piloted a virtual support group through a now discontinued social networking platform called Mxit, and found high acceptability, although users preferred more ubiquitous platforms such as WhatsApp. Further data is needed on the potential of virtual peer support to augment or substitute for in-person peer support across contexts and technologies.
Although most examples found peer support to positively influence AYPLHIV outcomes, one study in Kenya [ 28 ] reported no significant improvement in retention after monthly peer support groups, health provider training in AFHS, and a dedicated adolescent and youth clinic day. The authors suggested that the null finding may have been due to the heterogeneity of peer support services across the facilities investigated.
With few program descriptions and operational evaluations published on peer support interventions in low- and middle-income countries [ 29 — 31 ], there is often a reliance on anecdotal evidence to suggest that peer support interventions for AYPLHIV provide an effective mechanism for improved linkage, ART adherence, retention within HIV services, VLS, and psychosocial well-being.
Furthermore, the highlighted examples may not be generalizable and had shortcomings within their program descriptions that may limit the extent to which implementers can utilize their findings to change healthcare practice. First, the heterogeneity of terminology around the operationalization of peer support poses a major challenge to literature reviews and meta-analyses, delaying the establishment of a body of evidence to promote peer support.
In the examples highlighted here, peer support was not well labeled, defined or described. Second, most examples of peer-support are facility based with the exception of Zvandiri, which provided peer support both in the facility and community. More information is needed to assess whether physical location impacts effectiveness.
Third, further description is needed around the use of technology to enhance peer support. None of the highlighted examples included a description on the extent to which SMS, WhatsApp, and other social media are being used to enhance or replace in-person peer support if at all. As this has been observed to be common practice, more information is needed in this area. Fourth, descriptions of peer support may be limited due to potential publication bias, since most reports, evaluations, and articles were authored by the program owners.
Among the examples highlighted, it was often unclear whether technical review or external evaluation had taken place. Lastly, most examples that included evaluation of outcomes had small sample sizes—both number of peer supporters and clients—making it difficult to extrapolate generalizations that can be confidently applied to populations beyond those of the said programs. There is an urgent need for operational research to assess the effectiveness of, and best practices within, peer support programs.
Studies and program evaluations tend to report on programmatic approaches at a conceptual level, with insufficient granularity to ascertain the specifics of program implementation. Where these are reported, significant variation exists in terms of peer supporter characteristics, what qualifies and enables them to provide peer support, if and how they are compensated, the way in which peer support activities are structured, and the platforms used for delivery.
What follows is therefore a summation of existing written descriptions, as well as the personal observations and views of the authors, about the specific elements of successful programs that should be adopted, as well as programmatic pitfalls and challenges. Programs should recruit peer supporters based on explicit criteria, such as living openly with HIV and adhering successfully to treatment and care [ 33 ]. Peer supporters can be age-matched to their target client population, although we recommend that programs opt for peer supporters who are a few years older but still relatable as near-peers [ 34 ].
Peer supporter gender must also be carefully considered in relation to target population. Peer supporters require preparation, training and skills-building around how to provide psychosocial support for adolescents and young people, facilitate support groups, deliver health, HIV and adherence education, identify urgent cases of treatment failure and psychosocial need, operate within a professional environment, support bi-directional referrals between facility-based teams and community-based services, manage ethical dilemmas, and build leadership skills and confidence [ 34 , 35 ].
Programs should have defined training curricula and standards. It is important for peer support to be included in existing health facility structures, processes, and activities [ 34 ]. Some features of the site may not work correctly. DOI: Mahat , M. Scoloveno Published 1 May Medicine Research and Theory for Nursing Practice There is empirical evidence suggesting that peer education is efficacious in changing adolescent sexual risk behaviors; however, it is unclear if there are similarities in outcomes across studies.
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