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Participants (n\u2009=\u2009739) were 42% female, mostly White (89%) and non\u2010Hispanic (96%), unstably housed (57%), and reported lifetime injection drug use (93%). The most common drugs of choice were methamphetamine (42%) and heroin (38%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention and Comparator<\/jats:title>\n                    <jats:p>Participants were allocated (1:1, stratified by site), to: [1] standard retention approach involving appointment reminders and contact information updates by study staff (n\u2009=\u2009365), or [2] the intervention arm, receiving the standard retention approach and asked to recruit a \u201cstudy buddy\u201d (n\u2009=\u2009374). Study buddies were invited to view a training video and instructed to encourage their intervention participant to attend follow\u2010up appointments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>Intervention, control, and study buddy participants completed interviewer\u2010administered surveys at baseline and at 6 and 12\u2009months. Outcomes included retention at 12\u2009months (primary) and 6\u00a0months (secondary).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Retention was 50.3% at 6\u00a0months and 46.1% at 12\u2009months. Only 23.5% of intervention participants recruited a study buddy. In intent\u2010to\u2010treat analyses, the intervention did not increase retention at 12 (adjusted odds ratio [AOR] 1.08, 95% confidence interval [CI] 0.79\u20131.47) or 6 (AOR 0.96, 95% CI 0.69\u20131.34) months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Recruitment of self\u2010identified \u201cstudy buddies\u201d did not appear to statistically significantly improve retention of rural people who use drugs in this longitudinal study at 6\u2010 and 12\u2010month follow\u2010up relative to standard retention approaches.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.70250","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T06:35:32Z","timestamp":1764052532000},"page":"894-907","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Can a participant\u2010referred \u2018study buddy\u2019 increase retention of rural people who use drugs in research? 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