Impact of Needle and Syringe Program Coverage on HIV Incidence in People Who Inject Drugs

Noroozi, Mehdi; Noroozi, Alireza; Mirzazadeh, Ali; Hajebi, Ahmad; Mehrabi, Yadollah; Hashemi, Sayed Saeed; Sharifi, Hamid; Ghoddousi, Seyed Ebrahim; Etemad, Korosh; Soori, Hamid

doi:10.5812/ijhrba.28929

Cited by 5 publications

(5 citation statements)

References 29 publications

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“…In a mathematical modeling study of HIV transmission among PWID in Kermanshah, Iran [12], the incidence rate of HIV was estimated as 1.02% in PWID with sufficient coverage of NSP, and 4.04% in PWID without sufficient coverage of NSP. The reduction in HIV incidence could be due to ongoing nationwide harm reduction program focused on unsafe injection and its associated harms in place since 2002 [35].…”

Section: Discussionmentioning

confidence: 99%

“…Needle/syringe exchanges, opioid substitution therapy, and substance use treatment are provided to PWID. Condom promotion and distribution, sexually transmitted infection (STI) treatment and reproductive health education are available for FSW as well as other key populations [8, 11, 12]. To assess the impact of these prevention interventions among targeted key populations, Iran has conducted several Integrated Bio-Behavioral Surveillance (IBBS) surveys among FSW (2010, 2015), prisoners (2009, and 2013) and PWID (2010, 2014).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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“…For instance, evidence suggests that ART awareness led to misconceptions about considering HIV as a non-communicable or curable disease. [16] Safe injecting practices prevent HIV transmission among PWID, [17,18] which, however, is compromised by various social-structural contextual factors such as social networks, peer pressure, fear of harassment, and inaccessibility to sterile needles or syringes. [19,20] Reports show that HIV-positive PWID follow specific strategies to reduce transmission risks, such as "being the last receiver," sharing with HIV-positive PWID and washing the needles/syringes before sharing.…”

Section: Discussionmentioning

confidence: 99%

Spatial heterogeneity of risk factors associated with HIV prevalence among men who inject drugs in India: An analysis of the data from the integrated bio-behavioral surveillance, India

Aridoss¹,

David²,

Jaganathasamy³

et al. 2022

Medicine

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People who inject drugs (PWID) are India’s third-largest vulnerable population to human immunodeficiency virus (HIV) infection. PWID in India are confined to certain geographic locations and exhibit varying injecting and sexual risk behaviors, contributing considerably to increasing HIV trends in specific regions. Spatial heterogeneity in risk factors among vulnerable PWID influences HIV prevalence, transmission dynamics, and disease management. Stratified analysis of HIV prevalence based on risk behaviors and geographic locations of PWID will be instrumental in strategic interventions. To stratify the male PWID based on their risk behaviors in each state and determine the HIV prevalence for each stratum. The behavioral data and HIV prevalence of the national integrated biological and behavioural surveillance (IBBS), a nationwide cross-sectional community-based study conducted in 2014 to 2015, was analyzed. Data from 19,902 men who inject drugs across 53 domains in 29 states of India were included. Women who inject drugs were excluded at the time of IBBS, and hence PWID in this study refers to only men who inject drugs. PWID were categorized based on their risk profile, and the corresponding HIV prevalence for each state was determined. HIV prevalence was the highest (29.6%) in Uttar Pradesh, with a high prevalence of risk behaviors among PWID. High HIV prevalence ranging between 12.1% and 22.4% was observed in a few states in East and North-East India and most states in central and North India. Unsafe injecting and sexual practices were significantly (P < .05) associated with higher HIV prevalence and more significantly in National Capital Territory of Delhi (P < .001). Unsafe injecting practices among PWID were proportionally higher in Western and Central India, whereas unsafe sexual behaviors were widespread among most states. Unsafe sexual practices among male PWID were common. The high prevalence of unsafe injecting had significant HIV infection and transmission risks in Western and Central India. The results emphasize the need for stratified, region-specific interventions and combination approaches for harm reduction among PWID. Strengthening the measures that facilitate the reduction of high-risk behaviors, adoption of safe practices, and utilization of HIV services will positively impact HIV prevention measures among PWID.

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“…Among IDUs, safe injecting practices mainly prevents HIV transmission [13,14]. Various social-structural contextual factors lead to unsafe injection practices.…”

Section: Discussionmentioning

confidence: 99%

Determining the Spatial and Risk Heterogeneity in HIV Prevalence among IDUs in India: Analysis Based on the Data from Integrated Biological and Behavioural Surveillance (IBBS), 2014-15

Aridoss

David

Jaganathasamy

et al. 2020

Preprint

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Background: Spatial and risk-related heterogeneity among high-risk HIV populations marks the prevalence, dynamics, and management of HIV. Identifying the spatial heterogeneity of disease prevalence and risk heterogeneity at a specific location is crucial for fine-tuning the strategic interventions. On this background, we analysed the behavioural data and HIV prevalence of IDUs, in a state-specific manner. Objectives: To structure the IDU population based on their risk of infection and location, and to determine the HIV prevalence for each of the IDU subpopulation based on their spatial distribution and risk profile. Methods: We analysed the behavioural data and HIV prevalence obtained from the National Integrated Biological and Behavioural Surveillance (IBBS), a nationwide cross-sectional community-based study conducted in 2014-2015. We included the data obtained from 19,902 IDUs across 53 domains in 29 states of India for analysis. We grouped the IDUs into different categories, based on their risk profile, and analysed the corresponding HIV prevalence among IDUs in each category for all states. Results: State-specific analysis of HIV prevalence among the IDUs exhibiting safe and high-risk characteristics revealed that the HIV prevalence was the highest in Uttar Pradesh irrespective of the risk-structure of the state. HIV infection was highly prevalent in the Central and most Northern states, and in a few East and North-Eastern Indian states. HIV Prevalence was predominantly higher among those IDUs self-reporting presence of at least one STI symptom, following unsafe injecting practices, IDUs with inconsistent condom usage with sexual partners (other than regular partners), and those with inadequate knowledge of HIV /AIDS. Conclusion: Stratified, region-specific interventions based on geographic risk-structure and combination-approaches are recommended to prevent HIV transmission among IDUs. Implementing measures to generate adequate awareness of STI, HIV, and injecting behaviours, specifically among IDUs in the Central and Northern states of India and advocating safe sexual practises among all IDUS will have a positive impact on HIV prevention measures among IDUs.

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Impact of Needle and Syringe Program Coverage on HIV Incidence in People Who Inject Drugs

Cited by 5 publications

References 29 publications

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

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

Spatial heterogeneity of risk factors associated with HIV prevalence among men who inject drugs in India: An analysis of the data from the integrated bio-behavioral surveillance, India

Determining the Spatial and Risk Heterogeneity in HIV Prevalence among IDUs in India: Analysis Based on the Data from Integrated Biological and Behavioural Surveillance (IBBS), 2014-15

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