Estimation of HIV incidence and its trend in three key populations in Iran

Abstract

In Iran, People Who Inject Drugs (PWID), Female Sex Workers (FSW), and prisoners are the main key populations at risk of HIV infection. This study aimed to evaluate the trend of HIV incidence among PWID, FSW and prisoners as an impact measure of HIV harm reduction and prevention efforts in Iran. Data were obtained from the two rounds of national bio-behavioral surveillance surveys among FSW (2010 (n = 872), 2015 (n = 1339)), PWID (2010 (n = 2417), 2014 (n = 2307)), and prisoners (2009 (n = 4536), 2013 (n = 5390)) through facility-based (FSW and PWID surveys) and cluster sampling (prisoner surveys). Time-at-risk was calculated assuming the age at first sex or drug injection as the beginning of the at-risk period and the age at the time of the interview or date when they received a positive HIV test result as the end of this period, adjusted for interval censoring. HIV incidence among PWID in 2014 was 5.39 (95% CI 4.71, 6.16) per 1,000 person-years (PY), significantly lower than in 2009 (17.07, 95% CI 15.34, 19.34). Similarly, HIV incidence was 1.12 (95% CI 0.77, 1.64) per 1,000 PY among FSW in 2015, a significant drop from 2010 (2.38, 95% CI 1.66, 3.40). Also, HIV incidence decreased among prisoners from 1.34 (95% CI: 1.08, 1.67) in 2009 to 0.49 (95% CI: 0.39, 0.61) per 1,000 PY in 2013. Our findings suggest that after an increase in the 2000s, the HIV incidence may have been decreased and stabilized among key populations in Iran.

Barriers and motivators to participation and retention in HIV/HCV cohort studies among people who inject drugs: a community consultation in Iran

“…Current harm reduction programs catered towards PWID in Iran include education, access to needle and syringe program (NSP) and opioid substitution therapy (OST). Further, HIV testing and referral is often available through voluntary counselling and testing centers (VCTC), drop-in centers (DIC), and recently via established but limited number of mobile clinics [14]. The management of HCV, on the other hand, continues to occur in tertiary healthcare which has failed to provide access to HCV care among the more marginalized populations, including people with drug use disorders [15,16].…”

Is AIDS related to social determinants of health in Iran? A systematic review

“…Although many scientific advances have been improved in the field of AIDS diagnosis, the disease has not been fully controlled in all countries since the spread of AIDS in the Middle East, North Africa, Eastern Europe and Central Asia is rising and still a serious threat to humanity (2). The number of people infected with the AIDS virus in Iran has reached to 75 700 (3). In our country, the first wave of the disease began with imported contaminated blood products.…”

Barriers and motivators to participation and retention in HIV/HCV cohort studies among people who inject drugs; A community consultation in Iran

“…Current harm reduction programs catered towards PWID in Iran include education, access to needle and syringe exchange program (NSP), opioid substitution therapy (OST) and substance use treatment. Further, HIV testing and referral is often available through voluntary counselling and testing centers (VCTC), drop-in centers (DIC), and recently via established but limited number of mobile clinics (14). The management of HCV, on the other hand, continues to occur in tertiary healthcare which has failed to provide access to HCV care among the more marginalized populations, including people with drug use disorders (15,16).…”

“…With regard to HIV incidence measurement, studies have been limited to modelling studies (25) or not nationally representative studies (26). Providing robust and reliable estimates of HIV/HCV incidence needs well-designed prospective cohort studies which are often challenging due to time and budget constraints in Iran (14). Therefore, they need to be planned thoroughly to address all possible eventualities and exceptions.…”