The Ganchero intervention: a pilot clinical trial with Puerto Rican migrants who inject drugs living in New York City

Abstract Background This study reports outcomes from a pilot test of the Ganchero Intervention, a community-driven, culturally grounded intervention to address disparate rates of HIV, hepatitis C virus (HCV), and overdose in migrant Puerto Rican people who inject drugs (PWID) through empowering Gancheros (PWID who inject others in exchange for drugs or money) to promote risk-reduction practices in their clients. Methods The intervention was evaluated in a nonrandomized, wait-list control pilot trial in two neighborhoods in New York City from July 2024–October 2025. In Cycle I, Neighborhood A received the intervention and Neighborhood B served as a control; Neighborhood B received the intervention in Cycle II. Fisher’s exact and Mann–Whitney U tests compared baseline characteristics of the two neighborhood samples, and participants who did, versus did not, complete a follow-up. Negative binomial regression models tested group (intervention versus control neighborhood), time, and group by time effects for two outcomes of interest in Cycle I: past-30-day rates of sterile syringe use; and naloxone carriage, both assessed in Ganchero clients. Results The baseline assessment included 58 participants (clients of Gancheros; 28 in Neighborhood A and 30 in Neighborhood B). Compared to the sample from Neighborhood B, Neighborhood A participants had spent less time living in Puerto Rico, reported more frequent re-use of their own syringes, and reported less frequent visits to brick-and-mortar syringe services programs (SSPs), although there were no significant differences in mobile SSP use, demographics, drug use, injection frequency, overdose, arrest/incarceration, or naloxone training/carriage. In the analysis of rates of sterile syringe use during Cycle I (n=98 observations from 57 participants): compared to the control group (Neighborhood B), the intervention group (Neighborhood A) had a 25% significantly higher relative increase in sterile syringe use from baseline to the end of Cycle I (8 months post-baseline). Increases in reported naloxone carriage (n=99 observations for 57 participants), reported by both groups, did not significantly differ between the intervention and control groups. Conclusions Community-vetted and culturally appropriate access to sterile syringes, driven by Gancheros, holds promise for reducing HIV and HCV transmission in this culturally distinct population, although naloxone hesitancy challenges overdose prevention efforts. Trial registration The clinical trial protocol was pre-registered at ClinicalTrials.gov on March 11, 2024 (NCT06316739).