Access to needle and syringe programs and the relationship to equipment sharing among people who inject drugs in Kermanshah, Iran

ABSTRACT

Background: Needle and Syringe Programs (NSP) have been implemented in Iran since 2002. The primary aim of NSP is to prevent blood-borne virus transmission by providing sterile injecting equipment and information on safer injection practices. However, while NSP has been implemented in Iran for more than a decade, only a limited number of studies have evaluated the effect access to NSP has in reducing risk behaviors among people who inject drugs (PWIDs).Methods: Between September and December 2014 we used snow ball sampling to recruit PWID from Kermanshah for a cross-sectional survey. Participants completed a face-to-face interview and provided information on the frequency of injection and drug-related risk behaviors such as sharing (borrowing or lending) of previously used syringes/needles and the number of injecting partners with whom they have shared syringes/needles in the two months prior to interview. Correlation between drug-related risk behaviors and ability to access NSPs was assessed by bivariate and multiple logistic regression through the estimation of odds ratios (OR) and 95% confidence intervals (95% CI).Results: Of 500 PWIDs in this study, 18%, 36% and 46% reported low, medium and high ability to access NSPs in the two months prior to interview, respectively. The odds of receptive syringe sharing among people with low-access was 3.5 times the odds of people with high-access when adjusted for covariates and remained statistically significant (adjusted odds ratio (AOR): 3.5, 95%CI 1.4–7.7). The relationship between access to NSP and use of sterile-injecting equipment was not statistically significant. The AOR for outcomes like paraphernalia sharing (AOR: 2.5, 95%CI: 0.6–4.6, p-value: 0.6) was not statistically significant.Conclusions: Similar to the previous research in international settings, this study found that PWID who reported to have more access to needle and syringe programs were less likely to use a syringe after someone else had used it. NSP program staff should focus on encouraging more frequent visits, increasing the opening hours and number of locations providing access to sterile syringe in settings with high concentrations of PWID.

KEYWORDS:

• Needle and syringe programs
• people who inject drugs
• logistic regression

Acknowledgments

We gratefully thank all staff in the Drop-in Centre in Kermanshah who contributed in recruiting (Ms. Barkhordar) and data collection/interview (Mr. Azad and Mr. Amini). We profoundly thank people who were generous for their time and participated in the study. We also want to appreciate Mostafa Shokoohi and other experts from Regional Knowledge Hub for HIV Surveillance who provided valuable inputs to the study protocol and the questio- nnaire.

Declaration of interest

All authors had no conflicts of interest to be declared.

Funding

This study funded by Substance Abuse Prevention and Treatment Office (SAPTO) of Mental Health, Social Health and Addiction Department (MeHSHAD) of Ministry of Health and Medical Education, Islamic Republic of Iran.

Additional information

Funding

This study funded by Substance Abuse Prevention and Treatment Office (SAPTO) of Mental Health, Social Health and Addiction Department (MeHSHAD) of Ministry of Health and Medical Education, Islamic Republic of Iran.

Notes on contributors

Fatemeh Rezaie

Mohammad Najafi, Mohamd Hassan Farhadi, and Faremaeh Rezaei coordinated the study and collected the data in the field. Mehdi Noroozi, Ali Farhoudian, and Alireza Noroozi were responsible for the statistical analysis and writing the paper. Maryam Ranjbar and Meroe Vameghi drafted the manuscript. Ali Bazrafshan, Peter Higgs, and Farahnaz Mohammadi provided assistance in analyzing and interpreting the data. All authors read and approved the final manuscript.

Mohammad Hassan Farhadi

Mohammad Najafi, Mohamd Hassan Farhadi, and Faremaeh Rezaei coordinated the study and collected the data in the field. Mehdi Noroozi, Ali Farhoudian, and Alireza Noroozi were responsible for the statistical analysis and writing the paper. Maryam Ranjbar and Meroe Vameghi drafted the manuscript. Ali Bazrafshan, Peter Higgs, and Farahnaz Mohammadi provided assistance in analyzing and interpreting the data. All authors read and approved the final manuscript.

Ali Farhoudian

Mohammad Najafi, Mohamd Hassan Farhadi, and Faremaeh Rezaei coordinated the study and collected the data in the field. Mehdi Noroozi, Ali Farhoudian, and Alireza Noroozi were responsible for the statistical analysis and writing the paper. Maryam Ranjbar and Meroe Vameghi drafted the manuscript. Ali Bazrafshan, Peter Higgs, and Farahnaz Mohammadi provided assistance in analyzing and interpreting the data. All authors read and approved the final manuscript.

Mohammad Najafi

Mohammad Najafi, Mohamd Hassan Farhadi, and Faremaeh Rezaei coordinated the study and collected the data in the field. Mehdi Noroozi, Ali Farhoudian, and Alireza Noroozi were responsible for the statistical analysis and writing the paper. Maryam Ranjbar and Meroe Vameghi drafted the manuscript. Ali Bazrafshan, Peter Higgs, and Farahnaz Mohammadi provided assistance in analyzing and interpreting the data. All authors read and approved the final manuscript.

Ali Bazrafshan

Mohammad Najafi, Mohamd Hassan Farhadi, and Faremaeh Rezaei coordinated the study and collected the data in the field. Mehdi Noroozi, Ali Farhoudian, and Alireza Noroozi were responsible for the statistical analysis and writing the paper. Maryam Ranjbar and Meroe Vameghi drafted the manuscript. Ali Bazrafshan, Peter Higgs, and Farahnaz Mohammadi provided assistance in analyzing and interpreting the data. All authors read and approved the final manuscript.

Peter Higgs

Mohammad Najafi, Mohamd Hassan Farhadi, and Faremaeh Rezaei coordinated the study and collected the data in the field. Mehdi Noroozi, Ali Farhoudian, and Alireza Noroozi were responsible for the statistical analysis and writing the paper. Maryam Ranjbar and Meroe Vameghi drafted the manuscript. Ali Bazrafshan, Peter Higgs, and Farahnaz Mohammadi provided assistance in analyzing and interpreting the data. All authors read and approved the final manuscript.

Farahnaz Mohammadi Shahboulagh

Mohammad Najafi, Mohamd Hassan Farhadi, and Faremaeh Rezaei coordinated the study and collected the data in the field. Mehdi Noroozi, Ali Farhoudian, and Alireza Noroozi were responsible for the statistical analysis and writing the paper. Maryam Ranjbar and Meroe Vameghi drafted the manuscript. Ali Bazrafshan, Peter Higgs, and Farahnaz Mohammadi provided assistance in analyzing and interpreting the data. All authors read and approved the final manuscript.

Maryam Ranjbar

Mohammad Najafi, Mohamd Hassan Farhadi, and Faremaeh Rezaei coordinated the study and collected the data in the field. Mehdi Noroozi, Ali Farhoudian, and Alireza Noroozi were responsible for the statistical analysis and writing the paper. Maryam Ranjbar and Meroe Vameghi drafted the manuscript. Ali Bazrafshan, Peter Higgs, and Farahnaz Mohammadi provided assistance in analyzing and interpreting the data. All authors read and approved the final manuscript.

Meroe Vameghi

Mohammad Najafi, Mohamd Hassan Farhadi, and Faremaeh Rezaei coordinated the study and collected the data in the field. Mehdi Noroozi, Ali Farhoudian, and Alireza Noroozi were responsible for the statistical analysis and writing the paper. Maryam Ranjbar and Meroe Vameghi drafted the manuscript. Ali Bazrafshan, Peter Higgs, and Farahnaz Mohammadi provided assistance in analyzing and interpreting the data. All authors read and approved the final manuscript.

Mohammad Abbasi

Mohammad Najafi, Mohamd Hassan Farhadi, and Faremaeh Rezaei coordinated the study and collected the data in the field. Mehdi Noroozi, Ali Farhoudian, and Alireza Noroozi were responsible for the statistical analysis and writing the paper. Maryam Ranjbar and Meroe Vameghi drafted the manuscript. Ali Bazrafshan, Peter Higgs, and Farahnaz Mohammadi provided assistance in analyzing and interpreting the data. All authors read and approved the final manuscript.

Alireza Noroozi

Mohammad Najafi, Mohamd Hassan Farhadi, and Faremaeh Rezaei coordinated the study and collected the data in the field. Mehdi Noroozi, Ali Farhoudian, and Alireza Noroozi were responsible for the statistical analysis and writing the paper. Maryam Ranjbar and Meroe Vameghi drafted the manuscript. Ali Bazrafshan, Peter Higgs, and Farahnaz Mohammadi provided assistance in analyzing and interpreting the data. All authors read and approved the final manuscript.

Mehdi Noroozi

Mohammad Najafi, Mohamd Hassan Farhadi, and Faremaeh Rezaei coordinated the study and collected the data in the field. Mehdi Noroozi, Ali Farhoudian, and Alireza Noroozi were responsible for the statistical analysis and writing the paper. Maryam Ranjbar and Meroe Vameghi drafted the manuscript. Ali Bazrafshan, Peter Higgs, and Farahnaz Mohammadi provided assistance in analyzing and interpreting the data. All authors read and approved the final manuscript.