{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T06:12:26Z","timestamp":1788502346552,"version":"build-2803163510"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Community Health Advocates (CHAs) are widely employed as outreach workers for people who use drugs (PWUD), yet there is limited evidence on how to design capacity-building interventions that strengthen peer-driven behavior change in binational border settings. This study examined a structured capacity-building model that trained peer CHAs in Ciudad Ju\u00e1rez, Mexico, and El Paso, Texas to deliver an HIV prevention and skills-building intervention to PWUD and assessed its impact on HIV risk and protective behaviors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We employed two complementary evaluation methods: (1) a quantitative survey with participants, and (2) in-depth interviews with CHAs. Quantitatively, generalized linear models estimated effects of intervention participation on condom procurement, procurement of sanitized syringes, and condomless sex with substance-using partners, followed by a path model testing whether receipt of HIV prevention information mediated the association between peer-attributed behavior change and condomless sex. Qualitatively, in-depth semi-structured interviews with CHAs, analyzed using a rapid qualitative approach, explored how CHAs experienced training and evolving roles, and how they perceived peer communication and information diffusion as mechanisms of change.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>CHAs assumed expanded responsibilities, including delivering rapid HIV testing, organizing community events targeting structural determinants of HIV risk, and implementing peer-driven, network-based behavioral interventions; over time, they evolved into peer navigators and recovery coaches, facilitating linkage to harm reduction, HIV care, and overdose prevention while maintaining cultural and linguistic congruence with binational PWUD communities. Higher levels of peer-attributed behavior change were strongly associated with receiving a broader range of HIV prevention information topics, and greater receipt of information was associated with lower levels of condomless sex. Peer-attributed behavior change exerted a significant indirect effect through receipt of information, while qualitative data highlighted how trust, lived experience, and incremental practice changes supported these pathways.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A structured, culturally attuned capacity-building model can transform CHAs into peer interventionists, navigators, and recovery coaches who deliver network-based HIV and overdose prevention strategies in binational settings. Peer-attributed behavior change appears to reduce condomless sex primarily by increasing exposure to HIV prevention information, underscoring information diffusion through peer networks as a key mechanism for lowering HIV-related sexual risk in marginalized cross-border communities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1811496","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:28:31Z","timestamp":1788499711000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Transforming community health advocates into peer interventionists: a binational harm reduction model"],"prefix":"10.3389","volume":"14","author":[{"given":"Julia","family":"Lechuga","sequence":"first","affiliation":[{"name":"Division of Prevention Science, Department of Medicine, The University of California, San Francisco","place":["San Francisco, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebeca","family":"Ramos","sequence":"additional","affiliation":[{"name":"Programa Compa\u00f1eros","place":["Ciudad Juarez, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilberto","family":"Perez","sequence":"additional","affiliation":[{"name":"Programa Compa\u00f1eros","place":["Ciudad Juarez, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Elena","family":"Ramos","sequence":"additional","affiliation":[{"name":"Programa Compa\u00f1eros","place":["Ciudad Juarez, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Rojas","sequence":"additional","affiliation":[{"name":"Programa Compa\u00f1eros","place":["Ciudad Juarez, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luisa","family":"Ramos","sequence":"additional","affiliation":[{"name":"Programa Compa\u00f1eros","place":["Ciudad Juarez, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o","family":"Ferreira-Pinto","sequence":"additional","affiliation":[{"name":"College of Health Sciences, The University of Texas at El Paso","place":["El Paso, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2199","DOI":"10.2105\/AJPH.2011.300386","article-title":"Community health workers can be a public health force for change in the United States: three actions for a new paradigm","volume":"101","author":"Balcazar","year":"2011","journal-title":"Am J Public Health"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1109","DOI":"10.1177\/0898264309340702","article-title":"Promoting healthy aging through community health workers","volume":"21","author":"Fisher","year":"2009","journal-title":"J Aging Health"},{"key":"ref3","volume-title":"Unequal Treatment: Confronting Racial and Ethnic Disparities in Health care","year":"2003"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1521\/aeap.2006.18.supp.196","article-title":"A model for capacity building in AIDS prevention programs","volume":"18","author":"Ramos","year":"2006","journal-title":"AIDS Educ Prev"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1521\/aeap.2009.21.3.181","article-title":"Effectiveness of peer education interventions for HIV prevention in developing countries: a systematic review and meta-analysis","volume":"21","author":"Medley","year":"2009","journal-title":"AIDS Educ Prev"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1186\/s12879-020-05003-9","article-title":"Peer education for HIV prevention among high-risk groups: a systematic review and meta-analysis","volume":"20","author":"He","year":"2020","journal-title":"BMC Infect Dis"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1003","DOI":"10.1080\/09540121.2017.1282105","article-title":"Effectiveness of peer-led interventions to increase HIV testing among men who have sex with men: a systematic review and meta-analysis","volume":"29","author":"Shangani","year":"2017","journal-title":"AIDS Care"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1159\/000471853","article-title":"Drugs, violence, and trauma in Mexico and the USA","volume":"26","author":"Puyana","year":"2017","journal-title":"Med Princ Pract"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1733","DOI":"10.1353\/hpu.2012.0177","article-title":"U.S. drug use and migration experiences of Mexican female sex workers who are injection drug users","volume":"23","author":"Ojeda","year":"2012","journal-title":"J Health Care Poor Underserved"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"71","DOI":"10.17711\/sm.0185-3325.2022.010","article-title":"Transition from first illegal drug use to first injection among people who inject drugs in northern Mexico: a retrospective survival analysis","volume":"45","author":"Ospina-Escobar","year":"2022","journal-title":"Salud Ment"},{"key":"ref11","article-title":"Expands City-Level HIV Data, Adding El Paso and Riverside County to Show Local Trends and Impact Across 60 U.S. Cities. AIDSVu [Internet]","year":"2025"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1016\/j.annepidem.2012.04.002","article-title":"The emerging HIV epidemic on the Mexico-US border: an international case study characterizing the role of epidemiology in surveillance and response","volume":"22","author":"Strathdee","year":"2012","journal-title":"Ann Epidemiol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e662","DOI":"10.1016\/S2352-3018(18)30245-7","article-title":"Beyond borders: the epidemiology of HIV and drug use at the US-Mexico border","volume":"5","author":"Melo","year":"2018","journal-title":"Lancet HIV"},{"key":"ref14","first-page":"1145","volume-title":"Principles of harm Reduction","year":"2026"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-025-04962-x","article-title":"Effects of a sequential community-based multi-component HIV intervention on sexual behavior, drug use and syringe sharing for people who inject drugs on the US-Mexico border: a quasi-experimental study","author":"Lechuga","year":"2025","journal-title":"AIDS Behav"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1016\/j.healthplace.2009.04.004","article-title":"A tale of two cities: social and environmental influences shaping risk factors and protective behaviors in two Mexico-US border cities","volume":"15","author":"Ramos","year":"2009","journal-title":"Health Place"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1001\/jama.300.5.571","article-title":"Mexico's evolving HIV epidemic","volume":"300","author":"Strathdee","year":"2008","journal-title":"JAMA"},{"key":"ref18","volume-title":"Border Health 2020: a Prevention and Health Promotion Initiative","year":"2015"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1177\/109019819402100302","article-title":"Empowerment forum: a dialogue between guest editorial board and readers","volume":"21","author":"Bernstein","year":"1994","journal-title":"Health Educ Q"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"320","DOI":"10.2105\/AJPH.2018.304737","article-title":"Core competencies and a workforce framework for community health workers: a model for advancing the profession","volume":"109","author":"Covert","year":"2019","journal-title":"Am J Public Health"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"S262","DOI":"10.1016\/j.amepre.2009.08.011","article-title":"Role development of community health workers: an examination of selection and training processes in the intervention literature","volume":"37","author":"O'Brien","year":"2009","journal-title":"Am J Prev Med"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1097\/JAC.0b013e31821c64d7","article-title":"Community health workers then and now: an overview of national studies aimed at defining the field","volume":"34","author":"Rosenthal","year":"2011","journal-title":"J Ambul Care Manage"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/10410230701283280","article-title":"Family communication and crisis","volume":"21","author":"Scholl","year":"2007","journal-title":"Health Commun"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"65","DOI":"10.2307\/20460088","article-title":"What is a human-rights based approach to health and does it matter?","volume":"10","author":"London","year":"2008","journal-title":"Health Hum Rights"},{"key":"ref25","first-page":"237","volume-title":"Contemporary Sociology","author":"Rose","year":"1983"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/ejsp.2420050102","article-title":"Social comparison and social identity: some prospects for intergroup behaviour","volume":"5","author":"Turner","year":"1975","journal-title":"Eur J Soc Psychol"},{"key":"ref27","first-page":"345","volume-title":"Social Influence Processes and Prevention","author":"Tindale","year":"1990"},{"key":"ref28","first-page":"345","volume-title":"Social Influence Processes and Prevention","author":"Fisher","year":"1990"},{"key":"ref29","first-page":"117","volume-title":"Dissemination and Implementation Research in Health: Translating Science to Practice","author":"Hamilton","year":"2018"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1596","DOI":"10.1177\/1049732320921835","article-title":"Rapid techniques in qualitative research: a critical review of the literature","volume":"30","author":"Vindrola-Padros","year":"2020","journal-title":"Qual Health Res"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual Res Psychol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1609","DOI":"10.1186\/s12889-020-09646-8","article-title":"Peer education for HIV prevention among high-risk groups: a systematic review and meta-analysis","volume":"20","author":"Shushtari","year":"2020","journal-title":"BMC Public Health"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1007\/s10461-010-9802-0","article-title":"The STEP into action study: a peer-based, personal network-focused HIV prevention intervention with injection drug users in Baltimore, Maryland","volume":"15","author":"Latkin","year":"2011","journal-title":"AIDS Behav"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1080\/10826080802347677","article-title":"Outcomes of a peer HIV prevention program with injection drug and crack users: the risk avoidance partnership","volume":"44","author":"Weeks","year":"2009","journal-title":"Subst Use Misuse"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1007\/s10461-022-03792-5","article-title":"Evaluating the mediating role of recall of intervention knowledge in the relationship between a peer-driven intervention and HIV risk behaviors among people who inject drugs","volume":"27","author":"Aroke","year":"2023","journal-title":"AIDS Behav"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1312","DOI":"10.1080\/09540121.2016.1178698","article-title":"Integrated respondent-driven sampling and peer support for persons who inject drugs in Haiphong, Vietnam: a case study with implications for interventions","volume":"28","author":"Ha","year":"2016","journal-title":"AIDS Care"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"e26241","DOI":"10.1002\/jia2.26241","article-title":"Injection network drivers of HIV prevention service utilization among people who inject drugs: results of a community-based sociometric network cohort in New Delhi, 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