Implementation and formative evaluation of a peer-led chemsex intervention targeting sexualised crystal methamphetamine and GHB use: the M3THOD study.

BACKGROUND: Gay, bisexual and other men who have sex with men (GBMSM) who use crystal methamphetamine and gamma hydroxybutyrate (GHB) in sexual contexts (otherwise known as chemsex) report barriers to accessing health services. Peer-led chemsex interventions may reduce barriers to care and provide meaningful therapeutic support, however, there have been few formal evaluations of such programs. M3THOD is a novel peer-led intervention based on the transtheoretical model of behaviour change comprising elements of harm reduction education, motivational interviewing and service navigation. In this formative evaluation we appraise the acceptability, appropriateness, and feasibility of M3THOD. METHODS: M3THOD aimed to support people to reduce chemsex-related harm, manage frequency of chemsex and access specialist services. The acceptability, feasibility and appropriateness of this service were assessed. We collected data from peers' field notes and conducted 33 semi-structured in-depth interviews. These were conducted with intervention clients (n = 15), eligible community members who did not receive an intervention (n = 9), M3THOD peer workers (n = 3) and their managers (n = 2) and partnering clinicians (n = 4). A thematic framework method was used to analyse data. RESULTS: M3THOD demonstrated acceptability among all stakeholders and was deemed appropriate, with the caveat that peer workers should be supported to operate within a framework of structured flexibility to dually ensure safety and person-centred care. Most participants reported dependence on crystal methamphetamine and desired ongoing rather than one-off peer support. M3THOD's feasibility was contingent on robust support for training, technical support, and pastoral care for peers, and strong clinical partnerships and referral pathways. CONCLUSIONS: M3THOD was valued by participants with unique information and support needs often unmet by sexual health, mental health and drug and alcohol services and reported that peers' personal experiences of chemsex facilitated rapid rapport, validated and mitigated clients' shame around chemsex. Our formative evaluation indicated that a peer intervention addressing chemsex is acceptable, appropriate, and feasible in contexts sufficiently resourced to provide substantial support for peer workers. Hiring a team of peer workers, providing training, ongoing coaching, monthly clinical supervision and establishing supportive relationships with co-located counsellors were said to enable the safe and effective delivery of this peer-led chemsex service.