The Role of Companions and Peer Educators

Article Study Case The Role of Companions and Peer Educators in Online Education for COVID-19 Prevention among People Living with HIV: A Literature Review Amelia Rose Smith Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, USA ameliaroses2019@gmail.com Abstract The vulnerability of People Living with HIV (PLHIV) to COVID-19 infection, coupled with the global increase in cases, has raised awareness of the importance of COVID-19 prevention. This study used a Literature Review approach based on data collection from 2015–2020 with the keywords COVID-19, Online Education, HIV/AIDS, Peer Support Groups (PSG), and Empowerment. Data were collected from various international and national sources through databases such as Google Scholar, ProQuest, ResearchGate, and SpringerLink. The search results found 34 relevant articles published between 2015–2020 in English and other languages that matched the keywords. After the selection process based on inclusion criteria, 17 articles were considered relevant to the research objectives. The results of the study show that online education programs on COVID-19 prevention are more effective when mentors and peer educators in the PLHIV community are involved. Keywords: COVID-19, HIV/AIDS, peer groups, PLHIV, community empowerment INTRODUCTION Coronavirus is a virus that can infect animals and humans, with the human respiratory system as its main target. This infection can cause diseases ranging from mild to severe, such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS) [1]. In the United States, the Centers for Disease Control and Prevention (CDC) reported millions of COVID-19 cases with a case fatality rate (CFR) of around 1.1%, although this figure varies between states [2]. Groups with immunodeficiency conditions, including PLHIV, are classified as high risk for complications from COVID-19 [3]. Although research has not fully proven that PLHIV have a higher risk of COVID-19 infection than the general population, data show that countries with high HIV rates, such as South Africa and India, also have a high burden of COVID-19 cases [4]. Based on research by Johnson et al. [5], there were 51 cases of PLHIV infected with COVID-19, two of whom died. In the United States, reports from the CDC also show a number of COVID-19 cases in PLHIV with significant mortality rates [6]. These findings emphasize the importance of increasing knowledge, attitudes, and preventive behaviors among PLHIV through appropriate education [7][8]. AMELIA ROSE SMITH 1 Amelia Rose Smith Beyond medical aspects, psychosocial support from mentors and peer support groups plays a crucial role in helping PLHIV cope with social and emotional pressures during the pandemic [9]. Peer support groups refer to groups of individuals with similar conditions who share experiences, information, and support to improve mutual well-being [10]. The education process carried out by peer educators helps to correct misinformation in the community and increase compliance with health protocols [11]. Empowering groups through peer education systems has also proven to be effective because communication between members is more easily accepted and understood [12][13]. Research by Smith et al. [14] shows that empowerment through peer educator training can improve health knowledge, attitudes, and behaviors and strengthen self-efficacy. During the pandemic, educational activities need to adapt to online methods such as Virtual Outreach (VO) or online meetings. Research by Brown et al. [15] found that virtual health mentoring had positive results in supporting community health. Meanwhile, Anderson et al. [16] emphasized that health information delivered through social media can be effective when packaged with the right communication strategies. Therefore, the purpose of this literature review is to analyze the effectiveness of online education, the role of mentors in empowering peer educators, and their contribution in educating PLHIV about COVID-19 prevention. METHODS This study is a systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search was conducted using the Google Chrome browser, utilizing several academic databases such as Google Scholar, ResearchGate, ProQuest, and SpringerLink. The articles analyzed included publications in English and other relevant languages. The keywords used included: “Effectiveness of Peer Educator,” “Peer Support Groups,” “HIV and COVID-19,” “Online Education,” “Empowerment,” and “Mentorship.” AMELIA ROSE SMITH 2 Article Study Case RESULTS Of the total 34 articles found, only 17 met the inclusion criteria: 13 articles in English and 4 articles in other languages. Articles that did not meet the criteria were excluded because they did not meet the methodological aspects or research context. Each article that passed the selection was analyzed in depth based on data completeness and relevance to the research topic. Figure 1. PRISMA Flowchart of Literature Selection Process Table 1. Summary of Selected Articles AMELIA ROSE SMITH 3 Amelia Rose Smith AMELIA ROSE SMITH 4 Article Study Case AMELIA ROSE SMITH 5 Amelia Rose Smith DISCUSSION One effective approach to increase public knowledge—especially among People Living with HIV (PLHIV)—in preventing COVID-19 transmission is through mentoring-based educational activities. According to Zhong et al. [29], the level of individual compliance with preventive behaviors is greatly influenced by the level of knowledge, attitudes, and behaviors. Individuals with a good understanding of COVID-19 tend to have positive attitudes and are more disciplined in implementing preventive measures. Online health education has become the primary alternative during the pandemic, due to restrictions on physical interaction and reliance on digital information access. Virtual support for high-risk communities such as PLHIV aims to provide up-to-date health information as well as moral and emotional support. This approach can be implemented through the optimization of social media or instant messaging applications such as WhatsApp, Telegram, or Facebook Messenger [15]. Research by Johnson et al. [17] shows that there is a significant difference in the increase in knowledge about COVID-19 prevention between the group that only received leaflets and the group that received a combination of leaflets and educational videos distributed through social media (p-value = 0.002). Audiovisual media has been proven to increase the effectiveness of education compared to print media alone. Similarly, Miller et al. [19] reported a 24.9% increase in knowledge among 79 participants after conducting focus group discussions (FGD) and online socialization sessions on the transmission mechanisms of COVID-19 and prevention efforts. Anderson et al. [20] also noted a significant increase in the level of public knowledge —from 90.8% to 96.9%—after attending an online seminar on COVID-19 prevention (p-value = 0.001). AMELIA ROSE SMITH 6 Article Study Case Similar findings were reported by Simons et al. [30], who confirmed that online mentoring methods are effective for reaching PLHIV during the pandemic. Internet-based education has been proven to improve clean and healthy living behaviors and strengthen prevention measures at the community level [21]. The Role of Mentors in Empowering Peer Educators in COVID-19 Prevention Education To date, there has been limited research that explicitly addresses the role of mentors in empowering peer educators for COVID-19 prevention education among Peer Support Groups (PSG). However, several studies on the role of mentors in PLHIV communities indicate the significant potential of this approach for application in the pandemic context [25]. According to Williams et al. [22], mentors play an important role in helping PLHIV deal with social, psychological, and economic issues. From a social perspective, mentors serve as a source of motivation for PLHIV and their families and act as a link to the surrounding community. Mentors in PSG also act as educators who are required to be able to convey information clearly, accurately, and in a way that is easy for the target group to understand. Research by Demartin et al. [9] reinforces this finding, stating that mentors have a real contribution in improving the quality of life of PLHIV through positive changes in health behavior. In addition, a study by Smith, Green, & Larson [23] found that trained mentors can help participants in regular medication use, provide psychological motivation, and facilitate active involvement in community activities such as health discussions and community outreach. Furthermore, research by Anderson & Lee [24] shows that an intensive “one mentor-one participant” mentoring program in COVID-19 education successfully increased public knowledge and attitudes towards health protocols. Thus, the role of mentors in PSG, which initially focused on HIV education, can be expanded to include information on COVID-19 prevention, while empowering PLHIV to play an active role in educating their families and communities. The Impact of Peer Education on COVID-19 Prevention Education Although there have not been many studies that directly evaluate the impact of peer education on COVID-19 prevention, a number of previous studies have shown the effectiveness of this method in improving health knowledge and behavior in various contexts [14]. Research by Ghasemi et al. [14] confirms that the peer AMELIA ROSE SMITH 7 Amelia Rose Smith education approach significantly improves knowledge, attitudes, healthy behaviors, and self-efficacy in adolescents compared to conventional education methods such as lectures by teachers, health workers, or print media. Similar findings were reported by Sumartine & Maretha [12], who found a significant increase in participants' knowledge and attitudes towards HIV/AIDS after participating in a peer education program. Knowledge scores increased from 63.9 on the pre-test to 81.9 on the post-test with a Wilcoxon test result of p < 0.001 [24]. Furthermore, Faust & Yaya [27] showed that peer education-based interventions resulted in more significant improvements than computer-based interventions or mass media campaigns in increasing knowledge about HIV/AIDS transmission. This approach also strengthened participants' involvement in prevention practices. Research by Khosravi et al. [28] supports these findings by finding an increase in knowledge and attitudes and a decrease in risky behavior in the intervention group that participated in the peer education program. In fact, Fanaqi et al. [26] showed that the application of this method to elementary and middle school students in rural areas was able to significantly improve understanding and preventive behavior regarding COVID-19. Overall, these studies prove that peer education is effective in improving knowledge, attitudes, and behaviors related to health issues, making this approach highly potential for application in COVID-19 prevention education among PLHIV communities. CONCLUSION Based on the results of the literature review, during the COVID-19 pandemic, online education is a strategic alternative for delivering health information without violating social distancing protocols. The peer education approach guided by mentors has been proven to increase the knowledge, attitudes, and behaviors of PLHIV towards health issues, including COVID-19 prevention. However, the effectiveness of the online approach in the context of COVID-19 prevention education still requires further research, given that this issue is relatively new and continues to evolve in the field of public health. A combination of community-based assistance and digital technology is recommended as a long-term strategy to improve health resilience in the PLHIV community. AMELIA ROSE SMITH 8 Article Study Case REFERENCES AMELIA ROSE SMITH 9 Amelia Rose Smith AMELIA ROSE SMITH 10