Opioid agonist therapy uptake among people who inject drugs: the findings of two consecutive bio-behavioral surveillance surveys in Iran

Abstract

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.

Validation of Self-reported Opioid Agonist Treatment Among People Who Inject Drugs Using Prescription Dispensation Records

“…19 In contrast, accuracy of self-reported current opioid agonist treatment was primarily compromised by false positives, which may be owed to social desirability bias or perceived negative consequences of reporting nontreatment (e.g., unable to participate further in paid research). [11][12][13][14] However, we did not find increased overreporting (lower specificity) among participants whose interview location offered on-site opioid agonist treatment. Further, all OiSIS-Toronto participants were paid for their time, treatment was not an explicit (or implied) requirement for participation, and interviews were not conducted in formal treatment settings or by clinical staff.…”

“…A primary concern is that some PWID may feel pressured to misreport current (or recent) use of opioid agonist treatment; such overreporting might be especially prominent when treatment is a real or perceived requirement for participation in paid research or study interviews occur in treatment settings. 11–14 For self-reported opioid agonist treatment measures with lengthy recall periods (e.g., “recent” treatment typically defined as any enrollment in the past 6 months), 1–4 an additional concern is misclassification due to imperfect memory, as some participants cannot accurately recount their treatment history over the inquired duration. 11 Despite these and other potential sources of inaccurate reporting (e.g., imprecise survey items or participants misunderstanding questions), 12 without validation data, the extent of misclassification in common self-reported opioid agonist treatment measures among PWID remains unknown.…”