Mehdi Noroozi

The effect of on-site and outreach-based needle and syringe programs in people who inject drugs in Kermanshah, Iran

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.

Comparing profile of people who inject drugs (PWID) accessing different types of needle and syringe programs or secondary distribution in Kermanshah, Iran

Abstract Background: Needle and syringe programs (NSPs) have been developed and implemented since 2002 in Iran. NSPs are largely delivered through fixed site and outreach services. Characterizing people who inject drugs (PWID) primarily using different sources of injecting equipment can help service design. Objective: The objective of the present study was to characterize and compare the risk behaviors of PWID according to their primary sources of clean needles and syringes in Kermanshah, Iran. Methods: We used data from a cross-sectional study of 500 PWID in Kermanshah. Behavioral and program data were also assessed to identify their main source of injection equipment, demographic characteristics, and risk behaviors. The Cochran–Armitage trend test was used to test for trends in characteristics and risk behaviors among the three sources for clean needles. We also ran a multinomial logistic regression to assess the individual characteristics of those who have reported the outreach or other sources of NSP over fixed sites as their main sources of clean needles and syringe. Results: As reported by study participants, their three main sources were fixed sites (n = 230, 46%), (n = 180, 36%) and secondary distribution ((n = 90, 18%). The odds of reporting outreach versus fixed site as main source was significantly higher in those with unstable housing (AOR = 2.8, p = 0.01), who started injection under 25 years of age (AOR = 2.7, p = 0.03), and who have longer duration of injections (AOR = 2.3, p = 0.02). Similarly, the odds of reporting secondary distribution versus fixed site as main source of needles and syringes was significantly higher in those with unstable housing (AOR = 3.2, p = 0.01). Conclusions: We observed a trend toward more risky injection behaviors among the users of fixed sites to outreach program users and then those who have reported other alternates as main sources. This can be explained by insufficient coverage of injections.

Social determinants and hepatitis C among people who inject drugs in Kermanshah, Iran: socioeconomic status, homelessness, and sufficient syringe coverage

ABSTRACT Introduction: It has been estimated that 2–4 million people in developing countries possess HCV infection driven by unsafe injection drug use each year that is extending to other population. High-risk injection behaviors are the leading cause of HCV infections among PWIDs. The purpose of this study was to survey prevalence of HCV and risk factors associated with HCV among injecting drug users. Methods: This cross-sectional study was carried out on 410 injection drug users in Kermanshah that were recruited through peer-referral and convenience sampling from two Drop-In Centers (DICs). Data were collected using structured information form, and data analysis was done with descriptive and logistic regression. Results: A total of 410 men who injected drugs participated in this study. The mean age ± standard deviation (SD) was 33.2 ± 7.3 (range 19–58) years, Overall, the prevalence of HCV infections was 42% (95%CI: 23.7–52.5). Trend test showed clear trends for living place, income, age of first injecting drug, age at first drug use across the two groups (P-value < 0.05), but there was no significant trend for marital status, education level, or age (P-value > 0.05). Conclusion: Developing the needle and syringe programs could reduce unsafe injection rate among PWIDs. Therefore, the more accurate and better coverage of NSP programs in PWID, the more reduce in needle sharing rate and HCV infection.

Patterns of HIV Risks and Related Factors among People Who Inject Drugs in Kermanshah, Iran: A Latent Class Analysis

ABSTRACT The objective of this study was to explore patterns of drug use and sexual risk behaviors among people who inject drugs (PWID) in Iran. We surveyed 500 PWID in Kermanshah concerning demographic characteristics, sexual risk behaviors, and drug-related risk behaviors in the month prior to study. We used latent class analysis (LCA) to establish a baseline model of risk profiles and to identify the optimal number of latent classes, and we used ordinal regression to identify factors associated with class membership. Three classes of multiple HIV risk were identified. The probability of membership in the high-risk class was 0.33, compared to 0.26 and 0.40 for the low- and moderate-risk classes, respectively. Compared to members in the lowest-risk class (reference group), the highest-risk class members had higher odds of being homeless (OR = 4.5, CI: 1.44–8.22; p = 0.001) in the past 12 months. Members of the high-risk class had lower odds of regularly visiting a needle and syringe exchange program as compared to the lowest-risk class members (AOR = 0.42, CI: 0.2–0.81; p = 0.01). Findings show the sexual and drug-related HIV risk clusters among PWID in Iran, and emphasize the importance of developing targeted prevention and harm reduction programs for all domains of risk behaviors, both sexual and drug use related.

Epidemiology of accidents and traumas in qom province in 2010.

Background Accidents are the most important public health challenges in our society. To prevent the accidents, the identification of their epidemiological features seems necessary. Objectives This study was conducted to reveal the epidemiological features of accidents and their casualties in Qom province in 2010. Patients and Methods A cross–sectional study was conducted on 29426 injured people referred to Qom province hospitals in 2010. Information about place, time, type of accidents and traumas and demographic variables had been collected in a veteran hospital. Data were analyzed by SPSS (version 16) software, using chi-square test and logistic regression. Results The incidence of accidents was about 27/1000 per year. The incidences of traffic accidents, motorcycle accidents, violence, burns, poisoning and suicides were 3, 1.6, 1.2, 0.3, 0.8, 0.37 cases per 1000 people respectively. Strikes (65%) and falls (12%) were the main causes of traumas. Forty-six percent of all injuries had occurred in 16 - 30 years groups. Most frequent accidents were as follows: fall (97%) and strike (50%) in < 12, violence (46%) in 20 - 29, suicide (71%) in 15 - 29, poisoning (34%) and burns (20%) among < 5 years old. Pedestrian and motorcycle accidents among +60 years old people were significantly higher than other (P = 0.000). Odds ratio for suicide among female was about 3.36 and in 16 - 30 age-group was 15.7 more than +60 years old group (P = 0.000). Conclusions Most traumas in Qom province occurred among younger age-groups and strikes and falls are the main causes of such traumas. Therefore, safeties to prevent falls and traffic regulations to reduce strikes can be effective strategies.

Decomposition of Economic Inequality in Needle and Syringe Programs Utilization to its Determinants among Men Who Inject Drugs in Tehran using Blinder–Oaxaca Decomposition Method

ABSTRACT Background: According to latest available data there are more of 300,000 people injects drug users (PWID) in Iran. Objectives: In this study, we used a Blinder–Oaxaca (BO) decomposition to explore the relative contributions of inequality in utilization of NSPs and to decompose it to its determinants in Teheran. Methods: We used data from a cross-sectional survey using snowball sampling to recruit 500 PWID from June to July 2016 in Tehran. Participants were reported injecting drug use in the past month, were able to speak and comprehend Farsi enough to respond to survey questions, and were able to provide informed consent to complete the interview. We used a BO method to decompose the role of economic inequality on utilization of needle and syringe programs. Results: A total 520 of clients participated in the study of which data was fully complete for 500. The selected predictor variables (age, education level, marital status, homelessness, HIV risk perception, and HIV knowledge) together explain 54% (8.5% out of 16%) of total inequality in utilization of needle and syringe programs and the remaining 46% constitute the unexplained residual. HIV risk perception status contributed about 38% (3.3% out of 8.5%) to the total health inequality, followed by HIV knowledge (26%) and education level were contributed 20% each, respectively. Conclusion: The results showed that contribution of economic inequalities in utilization of NSPs was primarily explained by the differential effects of HIV risk perception and HIV knowledge among PWID. Reducing HIV risk perception and increasing HIV knowledge might be essential to efforts to eliminate inequalities in access to NSPs among PWID.

Factors associated with HIV risk perception among people who inject drugs: Findings from a cross-sectional behavioral survey in Kermanshah, Iran

ABSTRACT Background: In Iran there are limited data regarding HIV risk perceptions among people who inject drugs (PWID). The objective of this study was to explore HIV risk perception and to examine factors associated with the perception of HIV risk among PWID in Iran. Methods: We surveyed 433 PWID in Kermanshah concerning demographic characteristics, sexual risk behaviors, HIV risk perception, and drug-related risk behaviors in the month prior to the study. Two classes of HIV risk perception (high vs. low) were identified. We used logistic regression to identify factors associated with high HIV risk perception. Result: Of 433 PWID who participated in this study, 36% (95% confidence interval; CI95%: 25.3%, 42.2%) of participants reported high HIV risk perception. Methamphetamine use (adjusted odds ration; AOR = 3.7, p < 0.05), or use of multiple drugs at the same time (AOR = 1.7, p < 0.05) was associated with higher HIV risk perception. Moreover, PWID who were NSP users had 2.8 times the odds of high risk perception compared with non-Needle and Syringe Program (NSP) users (AOR = 2.8) . Conclusion: This study implies that initiating drug use at a younger age, using methamphetamine, polydrug use, and needle- and syringe-exchange program utilization were predictors of higher HIV risk perception among PWID in Iran.

Exploration of brushing behavior among university students in Iran: a qualitative research

Abstract Background Currently, it is estimated that 40% of the Iranian population is less than 20 years old, and in the academic year of 2011–2012 about 4 million students of that age were educated. The general assessment of the outcomes of oral health programs and investigating determinants is substantial for developing future plans of oral health. This study was done with the aim of exploring brushing behavior among university students of Iran to specify and understand the important determinants of oral health behavior. Methods A qualitative research method was used. This study was conducted between August and November 2016 in Shahid Beheshti University. Maximum variation sampling was used among university attendees and 44 students with more than 2 years of study duration were selected to be included in the research. Semi-structured interviews were employed for data gathering. All of the recorded interviews and notes were accurately evaluated and data analysis was performed based on the content analysis. Results As a result of the interview analysis 16 main categories emerged: Religious Beliefs, Perceived Benefits, Perceived Barriers, Habitation, Salience of Behavior, Education, Subjective Norms, Peer Pressure, Observational Learning, Knowledge, Perceived Susceptibility, Perceived Severity, Outcome Expectation, Skills, Perceived Self-efficacy, and Perceived Behavioral Control. Codes of sub-theme and theme were identified in the study. Conclusion This present study provides additional evidence with respect to the religious beliefs and the impact of religious instructions in brushing among students. Salience of brushing behavior has been described as one of the structures in an integrated behavioral model. Despite earlier studies suggesting, that peer pressure only plays a role on children’s brushing behavior, our study showed that peer pressure is effective on adults as well.

Association of wrist circumference with cardio-metabolic risk factors: a systematic review and meta-analysis

Background and aims The association of Wrist Circumference (WrC) with cardio-metabolic risk factors is still contradictory. We aimed to systematically review the association of WrC with cardio-metabolic diseases among the general populations. Methods We systematically searched electronic databases such as PubMed/Medline, Web of Sciences, and Scopus without language restriction until March 2017. Observational studies that examined the association of WrC with any cardio-metabolic risk factors were included. Pooled association of WrC with metabolic syndrome (MetS) was estimated using a random-effect model, and heterogeneity among studies was assessed by I 2 index and Q test. Results A total of 14 papers including cohort study ( n  = 9), cross-sectional study ( n  = 4), and case–control study ( n  = 1) met the criteria and included. The eligible papers have been examined the association of WrC with any cardiovascular disorders ( n  = 8), metabolic syndrome ( n  = 4), insulin resistance (IR) ( n  = 5), diabetes mellitus ( n  = 2), impaired glucose tolerance ( n  = 1), cardio-metabolic risk factors ( n  = 2) and obesity/overweight ( n  = 1). In the whole population (both adults and pediatric population), high WrC increased the risk of MetS by 33% (Pooled OR = 1.33; 95% CI 1.20, 1.48; I 2  = 60.2%, p  = 0.04), while the pooled OR in adult populations was 1.27 (95% CI 1.15–1.41; I 2 : 32.8%, p  = 0.21). Qualitative synthesis showed that associations of WrC with other cardio-metabolic risk factors are conflicting. Conclusion High WrC increased the risk of MetS and other cardio-metabolic risk factors. However, due to limited studies, particularly in children, results should be declared with great caution. Further cohort studies are needed to clarify whether WrC is a suitable anthropometric index to predict cardio-metabolic disorders in adult and children populations in different societies. Level of evidence Level 1, systematic review and meta-analysis

Comparing Characteristics of Early-Onset Injection Drug Users to Those With Late-Onset Injection in Kermanshah, Iran

ABSTRACT Background: Characteristics and behaviors of early-onset injection drug users are under studied topics in Iran. This study aimed to identify and compare the demographic characteristics as well as the drug using behaviors of early-onset and late-onset injection drug users in Kermanshah, West Iran. Methods: In this cross-sectional study using snowball and convenience sampling, we recruited 450 people during the Fall of 2014 from two drop in centers in Kermanshah, Iran. We collected data through face-to-face interviews. Early-onset injection is defined as whether the person reported their first injection at 22 years of age or younger. Subsequently, late-onset injection is defined as 23 years of age or older. We compared the characteristics of the two groups through both univariate and multiple logistic analyses. Results: Overall, 54% (CI 95%: 44.3%, 62.2%) were early injectors. After controlling for low socioeconomic status, initiation of drug use at a young age, multiple drug use and methamphetamine use were all significantly associated with a higher likelihood of early-onset injection. Additionally, early-onset injection was associated with recent syringe borrowing (OR = 2.6, p = 0.001), recent syringe lending (OR = 1.4, p = 0.01), recent cooker sharing (OR = 3.2, p = 0.01) and injecting two or more times a day (OR = 2.2, p = 0.04). Conclusion: Early-onset injectors were more likely to report a lower socioeconomic status, initiation of first drug use at a younger age, using methamphetamine alongside polydrug use, and engaging in higher risk taking behaviors like borrowing needles. With these associations, the study emphasizes the need for drug-prevention programs to focus on the transition to injection drug use at younger ages.