Mapping and size estimation of people who inject drugs: an innovative approach for targeted harm reduction program in Iran

ABSTRACT

Background

Hotspot mapping of People Who Inject Drugs (PWIDs) is important for harm reduction program planning. The aim of this study is to estimate the numbers of PWIDs and their geographic distribution in Iran.

Methods

We used the hotspot mapping and size estimation method to estimate the number of drug users in four cities of Iran from December 2017 to January 2019. We calculated three estimates in each hotspot: a) Key Affected Population Key Informant (KAP-KI) estimate (drug users met in the hotspot), b) Non-KAP KI estimate (e.g., taxi drivers, shopkeepers nearby the hotspot); c) estimation made by field observers. Locations of hotspots were recorded by the field team and ArcGIS software was used for mapping.

Results

A total number of 335 hotspots were identified in four cities and 1524 key informants were interviewed. The forty four per cent of identified hotspots received harm reduction services. Ahvaz had the highest estimated number of PWIDs (843, range: 703–887), followed by Sari (346, range: 307–666), Yazd (228, range: 221–471) and district 2 of Tehran (18, range: 18–34).

Conclusion

Findings highlight the need to use hotspot mapping to identify new PWIDs hotspots and best location for drop-in centers (DIC) and to provide targeted harm reduction programs.

KEYWORDS:

• People who inject drugs
• people who use drugs
• mapping
• size estimation
• Iran
• illicit drug use

Ethics approval

The study methodology and ethical considerations were approved by the Research Ethics Committee of the Iran University of Medical Sciences.

Consent for publication

Not applicable.

Availability of data and materials

The datasets collected in this study are not available for public access due to sensitive information of PWID hotspot locations but are available from the corresponding author on reasonable request.

Acknowledgments

This study was extracted from a thesis prepared by Mahmoud Khodadoust to fulfill the requirements needed for earning a Ph.D. in Epidemiology. The authors would like to thank the Mental and Social Health office and the HIV/AIDS office of Iran’s Ministry of Health and Medical Education and the staff in mental and social health department of Ahvaz, Mazandaran, Iran and Yazd medical universities for their assistance.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors’ contributions

HS, NG, AM, AH, PA and HF contributed to the protocol development, MK, AB, NG, EG, TK, JV, FZ, MH and RD were involved in oversight of the implementation and data gathering process. NG, MK and HS contributed to the data analysis, AM, MK, NG, HS, AH, HF and PA were involved in drafts of the manuscript. All authors read and approved the final manuscript.

Additional information

Funding

This study was supported by the Mental and Social Health office and HIV/AIDS office of Iran’s Ministry of Health and Medical Education (grant number No. 1397-2-45-12334).