Characterizing opioid agonist therapy uptake among people who inject drugs in Iran: Results from a national bio-behavioral surveillance survey in 2020.


Author: Fatemeh Mehrabi, Soheil Mehmandoost, Ali Mirzazadeh, Alireza Noroozi, Fatemeh Tavakoli, Hossein Mirzaei, Mehrdad Khezri, Ghazal Mousavian, Nima Ghalekhani, Parvin Afsar Kazerooni, Fatemeh Navaiian, Mostafa Shokoohi, Hamid Sharifi, Mohammad Karamouzian

Theme: Epidemiology & Public Health Research Year: 2023

Background:
Injection drug use is the primary driver of the human immunodeficiency virus HIV epidemic in Iran. The objectives of our study were to measure the lifetime prevalence of no history of opioid agonist therapy (OAT) uptake among people who inject drugs (PWID) in Iran and identify the primary barriers to OAT uptake among PWID.

Methods:
We recruited 2,684 PWID with a history of drug injection in the previous year using a respondent-driven sampling approach from 11 geographically dispersed major cities in Iran. Participants were eligible if they were at least 18, had at least one injection drug use practice in the last year, had a valid coupon, and provided verbal consent. Eligible participants completed a face-to-face interview using a standard risk assessment questionnaire. Consenting participants also completed a rapid HIV and HCV test. Correlates of no lifetime uptake history of OAT medications were assessed through multivariable logistic regression models and the barriers to accessing OAT were summarized in three main themes.

Results:
Lifetime prevalence of no history of OAT uptake among PWID was 31.3% (95% CI: 29.5, 33.1), with significant heterogeneities across different cities, ranging from 7.4% in East Azerbaijan to 63.1% in Lorestan. In the multivariable analysis, younger age, high school education or above, no prior incarceration history, and shorter length of injecting career were significantly and positively associated with no history of OAT uptake. Individual-level barriers (e.g., mental health struggles), financial barriers (e.g., unaffordable cost of OAT services), and system-level barriers (e.g., service availability interfering with working hours, stigma and rejection from healthcare providers) were the main barriers to receiving OAT.

Conclusion:
Despite the increasing number of OAT services in Iran, there is significant disparity across the country regarding accessing OAT and several preventable barriers continue to undermine PWID’s access to OAT. Revisiting and revising Iran’s OAT-related implementation policies are warranted.

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