Seyed Saeed Hashemi Nazari1, Mehdi Noroozi2, Hamid Soori3, Alireza Noroozi4, Yadollah Mehrabi3, Ahmad Hajebi5, Hamid Sharifi6, Peter Higgs7, Ali Mirzazadeh8. 1. Safety Promotion and Injury Prevention Research Center, Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2. Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. 3. Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 4. School of Advanced Technologies in Medicine (SATM), Tehran University of Medical Sciences (TUMS), Tehran, Iran; Iranian National Center for Addiction Studies (INCAS), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences (TUMS), Tehran, Iran. 5. Mental Health Research Center, Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran. 6. Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. 7. National Drug Research Institute, Faculty of Health Sciences, Curtin University, Australia. 8. Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Global Health Sciences, University of California, San Francisco, CA, USA. Electronic address: ali.mirzazadeh@ucsf.edu.
Abstract
BACKGROUND: Needle and syringe programs (NSPs) are widely used to reduce harms associated with drug injecting. This study assessed the effect of facility-based (on-site services at drop-in centre) and outreach models of NSP on injection risk behaviours. METHODS: Self-reported data from 455 people who injected drugs (PWID) during 2014 in Kermanshah, Iran, were examined to measure demographic characteristics and risk behaviors. Self-reported and program data were also assessed to identify their main source of injection equipment. Participants were divided into three sub-groups: facility-based NSP users, outreach NSP users and non-users (comparison group). Coarsened exact matching was used to make the three groups statistically equivalent based on age, place of residence, education and income, and groups were compared regarding the proportion of borrowing or lending of syringes/cookers, reusing syringes and recent HIV testing. RESULTS: Overall, 76% of participants reported any NSP service use during the two months prior to interview. Only 23% (95%CI: 17-27) reported outreach NSP as their main source of syringes. Using facility-based NSP significantly decreased recent syringe borrowing (OR: 0.27, 95%CI: 0.10-0.70), recent syringe reuse (OR: 0.38, 95%CI: 0.23-0.68) and increased recent HIV testing (OR: 2.60, 95%CI: 1.48-4.56). Similar effects were observed among outreach NSP users; in addition, the outreach NSP model significantly reduced the chance of lending syringes (OR: 0.31, 95%CI: 0.15-0.60), compared to facility-based NSP (OR: 1.25, 95%CI: 0.74-2.17). CONCLUSION: These findings suggest that the outreach NSP model is as effective as facility-based NSP in reducing injection risk behaviours and increasing the rate of HIV testing. Outreach NSP was even more effective than facility-based in reducing the lending of syringes to others. Scaling up outreach NSP is an effective intervention to further reduce transmission of HIV via needle sharing.
BACKGROUND: Needle and syringe programs (NSPs) are widely used to reduce harms associated with drug injecting. This study assessed the effect of facility-based (on-site services at drop-in centre) and outreach models of NSP on injection risk behaviours. METHODS: Self-reported data from 455 people who injected drugs (PWID) during 2014 in Kermanshah, Iran, were examined to measure demographic characteristics and risk behaviors. Self-reported and program data were also assessed to identify their main source of injection equipment. Participants were divided into three sub-groups: facility-based NSP users, outreach NSP users and non-users (comparison group). Coarsened exact matching was used to make the three groups statistically equivalent based on age, place of residence, education and income, and groups were compared regarding the proportion of borrowing or lending of syringes/cookers, reusing syringes and recent HIV testing. RESULTS: Overall, 76% of participants reported any NSP service use during the two months prior to interview. Only 23% (95%CI: 17-27) reported outreach NSP as their main source of syringes. Using facility-based NSP significantly decreased recent syringe borrowing (OR: 0.27, 95%CI: 0.10-0.70), recent syringe reuse (OR: 0.38, 95%CI: 0.23-0.68) and increased recent HIV testing (OR: 2.60, 95%CI: 1.48-4.56). Similar effects were observed among outreach NSP users; in addition, the outreach NSP model significantly reduced the chance of lending syringes (OR: 0.31, 95%CI: 0.15-0.60), compared to facility-based NSP (OR: 1.25, 95%CI: 0.74-2.17). CONCLUSION: These findings suggest that the outreach NSP model is as effective as facility-based NSP in reducing injection risk behaviours and increasing the rate of HIV testing. Outreach NSP was even more effective than facility-based in reducing the lending of syringes to others. Scaling up outreach NSP is an effective intervention to further reduce transmission of HIV via needle sharing.
Authors: Mehdi Noroozi; Elahe Ahounbar; Salah Eddin Karimi; Sina Ahmadi; Mohammad Najafi; Ali Bazrafshan; Zahra Jorjoran Shushtari; Mohammad Hassan Farhadi; Peter Higgs; Fatemeh Rezaei; Hesam Ghiasvand; Asaad Sharhani; Bahram Armoon; Katherine Waye Journal: Int J Behav Med Date: 2017-08
Authors: Mehdi Noroozi; Ali Mirzazadeh; Alireza Noroozi; Hamid Sharifi; Peter Higgs; Zahra Jorjoran-Shushtari; Ali Farhoudian; Farbod Fadai; Farahnaz Mohhamadi-Shahboulaghi; Bahram Armoon; Ahmad Hajebi; Omid Massah Journal: Addict Health Date: 2016-07
Authors: Hamid Sharifi; Ali Mirzazadeh; Mostafa Shokoohi; Mohammad Karamouzian; Razieh Khajehkazemi; Soodabeh Navadeh; Noushin Fahimfar; Ahmad Danesh; Mehdi Osooli; Willi McFarland; Mohammad Mehdi Gouya; Ali Akbar Haghdoost Journal: PLoS One Date: 2018-11-29 Impact factor: 3.240
Authors: Alireza Noroozi; Ali Mirzazadeh; Ali Farhoudian; Ahmad Hajebi; Hamid Reza Khankeh; Peter Higgs; Hamid Sharifi; Bahram Armoon; Mehdi Noroozi Journal: J Res Health Sci Date: 2016