BACKGROUND: Engaging people who inject drugs (PWID) in research is challenging due to stigma, distrust, and structural barriers. Peer-led recruitment may enhance reach and equity, yet few studies have quantitatively evaluated its outcomes. METHODS: Between Feb 2021-Dec 2023, a Partnerships Lead with Lived Experience implemented three new recruitment strategies within the HEPCO cohort study of PWID in Montreal, Canada. Strategies extended research activities into the community through a flexible engagement model comprising pop-up research clinics (n = 109 events), street outreach (n = 29 events), and community kiosks (n = 26 events). Peer-led recruitment pipelines and strategy efficiency were quantified, and enrolment outcomes compared with traditional recruitment methods (e.g., word-of-mouth). RESULTS: Peer-led strategies generated >2000 interactions with community members and contributed 46% of new enrolments despite substantially fewer operational days (164 vs 450 for traditional strategies). Overall efficiency was 0.88 new enrolments per recruitment event, with kiosks and street outreach nearly twice as efficient as pop-up clinics (1.31, 1.28, and 0.67 new enrolments/event). Participants recruited through peer-led strategies were more likely to report recent unstable housing (71.8% vs. 52.1%) and incarceration (19.1% vs. 12.1%) but not sex work (3.5% vs. 9.1%). Peer-led strategies enrolled slightly higher proportions of women (19.0% vs. 16.2%) as well as ethnically and linguistically diverse participants (14.8% vs. 11.4% non-White; 20.4% vs. 13.2% non-French preferred language). CONCLUSION: Peer-led recruitment engaged participants with greater structural vulnerability and modestly increased gender, ethnic, and linguistic diversity. Such approaches can strengthen equity in substance-use research when peer leadership is adequately resourced and embedded from the outset.
Boisvert et al. (Thu,) studied this question.