UPTAKE AND CORRELATES OF OPIOID SUBSTITUTION TREATMENT AMONG PEOPLE WHO INJECT DRUGS IN IRAN

Background and Aim : Opioid substitution treatment (OST) is an important factor in reducing the risk of bloodborne infections, overdose, and mortality among people who inject drugs (PWID). This study assessed the pattern of OST use among PWID in Iran.Methods : Data were obtained from the two rounds of national bio-behavioral surveillance surveys among PWID (N = 1,783 in 2010 and N = 2,166 in 2014) through facilities and out-reach based health services and harm reduction settings using a facility-based sampling approach and contributing both behavioral and serological data. The binary outcome in present study was currently receiving OST. Independent variables were marital status (never married or ever married), history of ever incarceration (yes or no), substance type used in the past month (only opioid, only non-opioids, and Opioids and non-opioids) (Opioids=Opium, Opium sap, Heroin, Norchizak, Tamchizak, Buprenorphine Opium syrup, and Methadone without prescription, and Crack. Non-opioids= Hashish/grass/Cannabis, Marijuana, Ecstasy, Cocaine, and methamphetamine/crystal /Shishe). Bivariate and multivariable logistic survey regression models were used to determine the correlates of OST uptake for 2014 survey. Adjusted odds ratios (AORs) and 95% confidence intervals (95% CI) have reported.Results : The prevalence of currently being on OST in 2013 was statistically lower than 2010 (49.2% vs. 45.8%). In the multivariable model, receiving OST was positively associated with having a history of ever incarceration (AOR = 1.53; 95% CI: 1.14-2.05), and being ever married (AOR= 1.48; 95% CI: 1.18-1.86), while it was negatively associated with using only non-opioid substances (AOR = 0.47; 95% CI: 0.29-0.76), and concurrent use of opioid and non-opioid (AOR = 0.66; 95% CI: 0.51-0.86). Also, 58.4% and 28.7% of the PWIDs reported that had used Amphetamine-type stimulants and new psychoactive substances in past month respectively. However, merely 39.2% of them reported receiving OST.Conclusion : Despite Iran is one of the leading countries in the OST uptake according to WHO plans for Harm Reduction, OST uptake were lower than 50% in both rounds. Although, OST have high coverage in Iran’s prison, effective scheme should be considered for PWID who have not history of incarceration to improve OST uptake. Also, Establishment of stimulants treatment centers and their integration in to DIC services could be an effective strategy and should be strengthen in future planning.

Keywords:

People Who Inject Drugs (PWID) , HIV , Harm reduction program , Iran , OST