TY - JOUR
T1 - Opioid agonist therapy uptake among people who inject drugs
T2 - The findings of two consecutive bio-behavioral surveillance surveys in Iran
AU - Nakhaeizadeh, Mehran
AU - Abdolahinia, Zahra
AU - Sharifi, Hamid
AU - Mirzazadeh, Ali
AU - Haghdoost, Ali Akbar
AU - Shokoohi, Mostafa
AU - Baral, Stefan
AU - Karamouzian, Mohammad
AU - Shahesmaeili, Armita
N1 - Funding Information:
The authors received no funding for this specific paper. The surveys were funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria through UNDP Iran and by Ministry of Iran. For this paper, we also received support from the University of California, San Francisco’s International Traineeships in AIDS Prevention Studies (ITAPS), US NIMH, R25MH064712.
Funding Information:
We would like to acknowledge the contributions of supervisors and field staff from all collaborative universities who provided inputs to the study design and methods and assisted in implementation of the surveys and data collection. We would also like to thank the participants for taking their time and sharing their valuable information. MK is supported by the Vanier Canada Graduate Scholarship and the Pierre Elliott Trudeau Foundation Doctoral Scholarship. The HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance located at Kerman University of Medical Sciences in collaboration with the Iran’s Ministry of Health and Medical Education carried out the surveys.
Publisher Copyright:
© 2020 The Author(s).
PY - 2020/7/22
Y1 - 2020/7/22
N2 - Background: Opioid agonist therapy (OAT) uptake has been associated with multiple positive health outcomes among people who inject drugs (PWID). This study evaluated the pattern of OAT uptake among PWID in two consecutive national bio-behavioral surveillance surveys (2010 and 2014) in Iran. Methods: Data were obtained from two national bio-behavioral surveillance surveys (N 2010 = 1783 and N 2014 = 2166) implemented using convenience sampling at the harm reduction facilities and street venues in 10 geographically diverse urban centers across Iran. Multivariable logistic regression models were built to determine the correlates of OAT uptake for the 2014 survey, and adjusted odds ratios (AORs) along with 95% confidence intervals (CI) were reported. Results: The prevalence of OAT uptake decreased from 49.2% in 2010 to 45.8% in 2014 (P value = 0.033). OAT uptake varied across the studied cities ranging from 0.0 to 69.3% in the 2010 survey and 3.2 to 75.5% in the 2014 survey. Ever being married (AOR = 1.40; 95% CI 1.12, 1.75), having a history of incarceration (AOR = 1.56; 95% CI 1.16, 2.09), and human immunodeficiency virus (HIV) sero-positivity (AOR = 1.63; 95% CI 1.08, 2.50) were associated with OAT uptake. Conversely, PWID who reported using only non-opioid drugs (AOR = 0.43; 95% CI 0.26, 0.71) and those who reported concurrent use of opioid and non-opioid drugs (AOR = 0.66; 95% CI 0.51, 0.86) were less likely to uptake OAT. Conclusions: Although OAT uptake among PWID in Iran is above the 40% threshold defined by the World Health Organization, there remain significant disparities across urban settings in Iran. Importantly, the OAT services appear to be serving high-risk PWID including those living with HIV and those with a history of incarceration. Evaluating service integration including mental health, HIV and hepatitis C virus care, and other harm reduction services may support the optimization of health outcomes associated with OAT across Iran.
AB - Background: Opioid agonist therapy (OAT) uptake has been associated with multiple positive health outcomes among people who inject drugs (PWID). This study evaluated the pattern of OAT uptake among PWID in two consecutive national bio-behavioral surveillance surveys (2010 and 2014) in Iran. Methods: Data were obtained from two national bio-behavioral surveillance surveys (N 2010 = 1783 and N 2014 = 2166) implemented using convenience sampling at the harm reduction facilities and street venues in 10 geographically diverse urban centers across Iran. Multivariable logistic regression models were built to determine the correlates of OAT uptake for the 2014 survey, and adjusted odds ratios (AORs) along with 95% confidence intervals (CI) were reported. Results: The prevalence of OAT uptake decreased from 49.2% in 2010 to 45.8% in 2014 (P value = 0.033). OAT uptake varied across the studied cities ranging from 0.0 to 69.3% in the 2010 survey and 3.2 to 75.5% in the 2014 survey. Ever being married (AOR = 1.40; 95% CI 1.12, 1.75), having a history of incarceration (AOR = 1.56; 95% CI 1.16, 2.09), and human immunodeficiency virus (HIV) sero-positivity (AOR = 1.63; 95% CI 1.08, 2.50) were associated with OAT uptake. Conversely, PWID who reported using only non-opioid drugs (AOR = 0.43; 95% CI 0.26, 0.71) and those who reported concurrent use of opioid and non-opioid drugs (AOR = 0.66; 95% CI 0.51, 0.86) were less likely to uptake OAT. Conclusions: Although OAT uptake among PWID in Iran is above the 40% threshold defined by the World Health Organization, there remain significant disparities across urban settings in Iran. Importantly, the OAT services appear to be serving high-risk PWID including those living with HIV and those with a history of incarceration. Evaluating service integration including mental health, HIV and hepatitis C virus care, and other harm reduction services may support the optimization of health outcomes associated with OAT across Iran.
KW - Harm reduction
KW - Iran
KW - Opioid agonist therapy
KW - People who inject drugs
KW - Surveillance
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U2 - 10.1186/s12954-020-00392-1
DO - 10.1186/s12954-020-00392-1
M3 - Article
C2 - 32698875
AN - SCOPUS:85088442102
SN - 1477-7517
VL - 17
JO - Harm reduction journal
JF - Harm reduction journal
IS - 1
M1 - 50
ER -