Outcome assessment of a triangular clinic as a harm reduction intervention in Rajaee-Shahr Prison, Iran

Abstract

BackgroundTransmission of the human immunodeficiency virus (HIV) among incarcerated injection drug users (IDU) is a health epidemic in the Islamic Republic of Iran. Triangular clinics (TCs) were established in prisons as a harm reduction measure to decrease the risk of HIV transmission and other blood-borne infections. The objective of this study was to assess the immediate outcomes of one TC among male IDUs in Iran’s Rajaee-Shahr prison.MethodsThis study was conducted in two stages between 2003 and 2005. In the preparatory stage, focus group data was collected to update the prison’s TC education and medical interventions and construct the self-report questionnaire. In stage two, 150 male IDUs were recruited in a closed cohort study design to assess the immediate outcome of the TC. Participants were measured at baseline and followed up to six months to measure their drug use, attitude toward and knowledge of high risk behaviours, serological conversion for HIV, HBV and HCV, and engagement in risky behaviors. The TC outcomes were determined through random urine analysis testing, a self-administered questionnaire and behaviour report cards, and viral infection testing.ResultsThe findings of the urine analyses indicated a minimal yet consistent decrease in drug use over the six months. The pre and post- self-administered questionnaire data relayed a modest change in IDU risky behaviours associated with sexual practices; this was greater in comparison to the knowledge and attitude measures. It was determined that age may have a detrimental effect as may viral infections (HIV and HBV) on knowledge, attitude and behavior change. Both education and employment may have a protective effect. Data collected from the self-report behaviour cards similarly showed a modest reduction in high risk practices. At the six month follow-up, only one case became HIV positive, 9 HCV and 17 HBV.ConclusionsConsidering that HIV is concentrated among Iranian prisoners who inject drugs at a high level, the results of this study indicate that TCs are a possible effective intervention. However, many prisoners continued with risky behaviors even if they were participating in harm reduction measures, such as methadone maintenance therapy.

HIV prevalence among people who inject drugs (PWID) and related factors in Iran: a systematic review, meta‐analysis and trend analysis

“…and Taghizadeh Asl et al . , respectively. The prevalence of HIV in the current PWID was higher than its prevalence in the life‐time PWID (14.6%, 95% CI = 11.2–18.0 versus 9.2, 95% CI = 6.9–11.6).…”

Estratégias de redução de danos no uso prejudicial de álcool e outras drogas: revisão de literatura

“…They also offer substitution therapy. This was the case in Iran 40 and Malaysia 49 . There is a vast variation in the proposed activities, varying in accordance with the characteristics and necessities of the area in question.…”

“…The information can be re-passed verbally to the users of the services as well to the mutual help groups. Iran 15,40 , USA 23 , Thailand 18 , Switzerland 24 , India 29 , England 35,41 , Tanzania 32 and China 38 adopted informative interventions associated with other HR services. The preventative information can also be spread through printed material that usually accompany the supplies which is the case with the syringes, pipes and HR kits offered in the experiences in Brazil 4,21,32 and in Tanzania 42 .…”

Prison Inmates Living with HIV in India

“…The male young inmates had higher risk of HIV infection, as compared to older female inmates (Swartz et al 2004 ). Asl et al ( 2013 ) reported that the mean age of prison inmates living with HIV was 31.4 years. Kalantar & Alijev ( 2005 ) noted that the average age of HIV-infected prisoners was 20-25 years.…”

“…11 % of the participants reported being unemployed at the time of their incarceration. Fifty percent were single and had never been married, and of those who were married, 65 % had children (Asl et al 2013 ).…”