Understanding the Effectiveness of Peer Educator Outreach on Reducing Sexually Transmitted Infections: The Role of Prevention vs. Early Detection

In an effort to reduce sexually transmitted infections (STI) in developing countries, health organizations often recruit former sex workers as “peer educators” to counsel current sex workers. Although peer educator outreach (PEO) programs have generally been shown to reduce STI, it is not clear whether such efficacy is primarily driven by “prevention” (reducing the infection rate of STI through safe-sex education) or “detection” (educating sex workers about STI symptoms so that they will seek prompt treatment if/when infected). Such differentiation is not only of academic interest, but also has important practical implications on resource management. We develop an integrated Bayesian model to disentangle the role of prevention versus detection in PEO programs. Our results show that PEO programs appear to be not effective in preventing STI, but they do facilitate earlier detection by enhancing sex workers’ knowledge and ability to recognize STI symptoms. Simulations based on our model suggest that increasing PEO efforts by 10% from the current level would increase clinic visits by 1.0%, thereby reducing STI prevalence by around 3.0%. Further, we conducted a randomized controlled field experiment that provides directionally consistent evidence that PEO visits are effective in increasing clinic visits among sex workers.