The Effect of On-Site & Outreach-Based Needle & Syringe Programs in People Who Inject Drugs in Kermanshah, Iran

Highlights

• Outreach needle and syringe program (NSP) model is as effective as facility-based NSP in reducing the harm associated with drug injection.
• The outreach model is even more effective in reducing the lending of syringes.
• Both NSP models increase the rate of HIV testing.
• We found that less than one-quarter of people who inject drugs have access to NSP services through outreach services, which need to be scaled up.

Abstract

Background

Needle and syringe programs (NSP) are widely used to reduce harms associated with drug injection. This study assessed the effect of facility-based (on-site services at drop-in centre) and outreach NSP model on injection risk behaviours.

Methods

We used self-reported data from 455 people who inject drugs (PWID) during 2104 in Kermanshah, Iran to measure demographic characteristics and risk behaviors. We also used both self-reported and program data to identify their main source of injection equipments. Accordingly, we grouped participants into three sub-groups: facility-based NSP users, outreach NSP users and non-users (comparison group). Using coarsened exact matching, we made the three groups statistically equivalent based on age, place of residence, education and income; and compared them regarding the proportion of borrowing or lending syringes/cookers, reusing syringes and recent HIV testing.

Results

Overall, 76% of participants reported any NSP service use during the two months prior to the interview. Only 23% (95%CI: 17-27) reported the 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), while facility-based did not (OR: 1.25, 95%CI 0.74-2.17).

Conclusion

We found that outreach NSP model is as effective as facility-based NSP in reducing injection risk behaviours and in increasing the rate of HIV testing. The outreach model is even more effective in reducing the lending of syringes to other PWID in compare to facility-based NSP model. Scaling up outreach NSP is an effective intervention to further reduces the transmission of HIV via needle sharing.

Purchase full article at:  http://goo.gl/EDtMbp

By:  Mehdi Noroozi, Hamid Soori, Alireza Noroozi, Seyed Saeed Hashemi Nazari, Yadoallah Mehrabi, Ahmad Hajebi, Hamid Sharifi, Peter Higgs, Ali Mirzazadeh

Affiliations

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

Correspondence

Corresponding author.at: 550 - 16th Street, 3rd F, San Francisco CA 94158 Tel.: +415 476 5821.

 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health