Profiles of risk: a qualitative study of injecting drug users in Tehran, Iran

BACKGROUND: In Iran, there are an estimated 200,000 injecting drug users (IDUs). Injecting drug use is a relatively new phenomenon for this country, where opium smoking was the predominant form of drug use for hundreds of years. As in many countries experiencing a rise in injecting drug use, HIV/AIDS in Iran is associated with the injection of drugs, accounting for transmission of more than two-thirds of HIV infections. This study aimed to: describe the range of characteristics of IDUs in Tehran, Iran's capital city; 2) examine the injecting-related HIV risk behaviors of IDUs, and 3) suggest necessary interventions to prevent HIV transmission among IDUs and their families and sex partners. METHODS: Using rapid assessment and response methods with a qualitative focus, six districts of Tehran were selected for study. A total of 81 key informants from different sectors and 154 IDUs were selected by purposeful, opportunistic and snowball sampling, then interviewed. Ethnographic observations were done for mapping and studying injecting-related HIV risk settings and behaviors. Modified content analysis methods were used to analyze the data and extract typologies of injecting drug users in Tehran. RESULTS: Evidence of injecting drug use and drug-related harm was found in 5 of 6 study districts. Several profiles of IDUs were identified: depending on their socioeconomic status and degree of stability, IDUs employed different injecting behaviors and syringe hygiene practices. The prevalence of sharing injection instruments ranged from 30–100%. Varied magnitudes of risk were evident among the identified IDU typologies in terms of syringe disinfection methods, level of HIV awareness, and personal hygiene exhibited. At the time of research, there were no active HIV prevention programs in existence in Tehran. CONCLUSION: The recent rise of heroin injection in Iran is strongly associated with HIV risk. Sharing injection instruments is a common and complex behavior among Iranian IDUs. For each profile of IDU we identified, diverse and targeted interventions for decreasing sharing behavior and/or its harms are suggested. Some notable efforts to reduce the harm of injecting drug use in Iran have recently been accomplished, but further policies and action-oriented research for identification of effective preventive interventions are urgently needed

An international survey of patients with thalassemia major and their views about sustaining life-long desferrioxamine use

BACKGROUND: Management of thalassemia major requires patients to have life-long access to a treatment regimen of regular blood transfusions coupled with iron chelation therapy. The objective of this study was to investigate patients' reasons for missing iron chelation therapy with desferrioxamine, and the support to sustain life-long adherence to treatment. METHODS: From October 1999 to May 2000 a survey of patients with thalassemia major was conducted in ten countries: Cyprus, Egypt, Greece, Hong Kong, India, Iran, Italy, Jordan, Taiwan, and the United States. RESULTS: 1,888 questionnaires (65%) were returned. Most patients (1,573) used desferrioxamine, and 79% administered a dose at least 4 days a week. Inaccessibility of the drug was a common reason for missing a dose in India (51%), and in Iran (25%), whereas, in any other country, it was a reason for less than 17% of patients. Overall, 58% reported reasons for missing a dose related to their beliefs or feelings about the medication, and 42% drug-related side effects. CONCLUSION: Many patients miss doses of desferrioxamine and an opportunity remains to develop interventions that provide more support to sustain use of desferrioxamine

My place, your place, or a safer place : the intention among Montreal injecting drug users to use supervised injecting facilities

Pilot studies of supervised injecting facilities (SIF) are under consideration in Canada, but it is elemental to first establish acceptability among the injecting drug use (IDU) population that are potential attendees. This study aimed to assess SIT acceptability and to determine factors associated with the willingness of public injectors to use SIF in a city considering their establishment. From April 2001--February 2002, qualitative, key informant interviews and survey data collection methods were employed. Questions were appended to a study monitoring HIV risk among Montreal IDU. Univariate and bivariate analyses preceded logistic regression. 11 key informants and 251 IDU participated in the study. Key informants generated specific SIT models subsequently presented to IDU. Overall, SIF acceptability was high. Two logistic regression models presented factors independently predictive of potential SIF use including drug use characteristics and SIF attributes. Initial community and user consultations are essential in assessing relevance and planning of SIF

Long Term Cost-of-Illness in Stroke: An International Review

An international review of the costs of stroke was conducted to explore data sources, and cost variables as well as to compare estimates of the annual aggregated cost (prevalence-based) and total per patient long-term cost (incidence-based) of care. Dutch, English, French, German, Italian and Spanish literature was searched using the keywords stroke, ischaemic stroke, haemorrhagic stroke, cerebrovascular accident, cerebral infarction, cost(s), economics, and cost analysis. Criteria for study inclusion were: provides estimates of direct and/or indirect costs of stroke, published after 1989, methods described in adequate detail, and for studies of long-term costs, estimates based on a minimum 5 years of care following the event. Cost estimates are presented in original currencies and US dollars. Among studies representing Australia, New Zealand, Western Europe and North America, six prevalence studies reported total annual aggregated costs of $US7975 (1988 values) to$US54 546 (1993 values) per patient; eight incidence-based studies reported total long-term per patient costs of $US18 538 (1991 values) to$US228 038 (1990 values). Identifiable factors underlying variation included: perspective employed, cost variables considered, and exclusion of comorbidities. Although lack of uniformity hampers inter-study comparisons, it is evident that stroke poses a significant economic burden. Consensus on standard cost variables and methods for projections of resource use and survival over time are clearly warranted.Cost of illness, Pharmacoeconomics, Stroke

Protocol for the implementation of a statewide mobile addiction program

With overdose deaths increasing, improving access to harm reduction and low barrier substance use disorder treatment is more important than ever. The Community Care in Reach R model uses a mobile unit to bring both harm reduction and clinical care for addiction to people experiencing barriers to officebased care. These mobile units provide many resources and services to people who use drugs, including safer consumption supplies, naloxone,medication for substance use disorder treatment, and a wide range of primary and preventative care. This protocol outlines the evaluation plan for the Community in Care R model in MA, USA. Using the RE-AIM framework, this evaluation will assess how mobile services engage new and underserved communities in addiction services and primary and preventative care

Supplementary infographic: Protocol for the implementation of a statewide mobile addiction program

This is peer-reviewed supplementary infographic for the article 'Protocol for the implementation of a statewide mobile addiction program' published in the Journal of Comparative Effectiveness Research.</p