Co-Designing the PATH Harm Reduction Training for the Peer Workforce: A Community-Based Participatory Approach.

Background: Opioid use disorder and related overdoses remain a leading US public health challenge. Peer Recovery Specialists (PRS), individuals with lived experience who support others in recovery, frequently deliver harm reduction services but face high job demands, stigma, and role conflict due to abstinence-oriented norms. These stressors contribute to burnout, turnover, and diminished service quality. Despite growing recognition of PRSs' role in harm reduction, few interventions address their workforce development or resilience needs. To strengthen harm reduction delivery and workforce sustainability, we developed Peer Advanced Training in Harm reduction (PATH), a blended educational intervention co-designed with community partners using a Community-Based Participatory Research (CBPR) framework. Methods: PATH was designed to enhance PRSs' personal and job-related resources through (1) three one-hour eLearning modules that apply adult learning and narrative storytelling to shift stigmatizing attitudes and strengthen harm reduction skills, and (2) an ECHO-based case discussion series to build confidence, policy literacy, and organizational alignment. A Community Board (CB) of eight members with lived recovery, harm reduction, and related service experience guided iterative content prioritization across six meetings (February-June 2025). CB members brainstormed, ranked, and refined eLearning and ECHO topics through surveys and facilitated discussions. Cultural exchange surveys assessed perceptions of collaboration, communication, and trust between CB members and researchers at two time points. Results: CB deliberations identified relational harm reduction-emphasizing empathy, authenticity, and participant autonomy-as the unifying theme across all training modules. Four final eLearning modules emerged: Embracing the Harm Reduction Approach, Integrating Harm Reduction into Participant Recovery Plans, Supporting PRSs to Do Harm Reduction Work, and Advancing Harm Reduction. ECHO priorities were also refined to reflect the pragmatic nature of peer work as perceived by CB members. Cultural exchange ratings were uniformly high (mean > 5.5 on a 6-point scale), reflecting strong mutual respect, shared learning, and perceived impact. Conclusion: Through CBPR co-design, PATH demonstrates how centering people with lived/living experience can yield a culturally grounded, practice-ready workforce intervention that strengthens harm-reduction capacity and sustainability. Findings establish feasibility and guide the forthcoming pilot and subsequent clinical trial to assess PATH's impact on PRS workforce outcomes and service quality.