Programmatic mapping and size estimation of people who inject drugs to plan targeted HIV prevention and harm reduction programs in iran, a nationwide study
Abstract Background The HIV epidemic in Iran has been largely driven by people who inject drugs (PWID). Although harm reduction services have been implemented in Iran, some PWID still lack access to these services. This programmatic mapping aimed to determine the spatial distribution of hotspots, es...
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2025-07-01
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| Online Access: | https://doi.org/10.1186/s12889-025-23558-7 |
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| author | Nima Ghalekhani Ahmad Hajebi Ebrahim Ghodusi Behnaz Beygi Toktam Khojasteh Bojnordi Mohammad Farooq Mashhour Fatemeh Rezaei Sharif Farzaneh Rajabzadeh Hooriyeh Khoshdel Hamid Reza Fathi Hamid Sharifi |
| author_facet | Nima Ghalekhani Ahmad Hajebi Ebrahim Ghodusi Behnaz Beygi Toktam Khojasteh Bojnordi Mohammad Farooq Mashhour Fatemeh Rezaei Sharif Farzaneh Rajabzadeh Hooriyeh Khoshdel Hamid Reza Fathi Hamid Sharifi |
| author_sort | Nima Ghalekhani |
| collection | DOAJ |
| description | Abstract Background The HIV epidemic in Iran has been largely driven by people who inject drugs (PWID). Although harm reduction services have been implemented in Iran, some PWID still lack access to these services. This programmatic mapping aimed to determine the spatial distribution of hotspots, estimate the number of PWID, and assess the coverage of prevention services to plan optimal service locations in Iran. Methods A cross-sectional key informant-driven mapping and enumeration methodology was used to identify hotspots of illicit drug use in 82 cities across 24 provinces in Iran from August 2020 to March 2021. Results We identified 4,270 active hotspots, of which 3,350 (78.5%) were associated with people who inject drugs (PWID). An estimated 14,737 PWID (92.2% male) were identified, with 261 (1.8%) under 18 years old, 3,643 (24.7%) aged 18–29 years, 10,061 (68.3%) aged 30–59 years, and 775 (5.2%) over 60 years old. Only half of the hotspots for PWID have active programs, with 24% of services overlapping in coverage areas. Under resource limitation with 47% and 93% reduction in the centers and outreach teams, respectively, we can expect just a 14% decline in services, and this would be the optimum decision in the constrained situation. Conclusions This study provides conclusive evidence that the current spatial distribution of harm reduction services for PWID in Iran is inefficient, characterized by significant coverage gaps in high-risk areas alongside costly resource redundancy through service overlap. Strategic consolidation based on spatial optimization can dramatically improve efficiency and access under resource constraints. |
| format | Article |
| id | doaj-art-35dfa4e2f5e14822b68f949eeac16f7a |
| institution | DOAJ |
| issn | 1471-2458 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
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| series | BMC Public Health |
| spelling | doaj-art-35dfa4e2f5e14822b68f949eeac16f7a2025-08-20T03:06:39ZengBMCBMC Public Health1471-24582025-07-0125111310.1186/s12889-025-23558-7Programmatic mapping and size estimation of people who inject drugs to plan targeted HIV prevention and harm reduction programs in iran, a nationwide studyNima Ghalekhani0Ahmad Hajebi1Ebrahim Ghodusi2Behnaz Beygi3Toktam Khojasteh Bojnordi4Mohammad Farooq Mashhour5Fatemeh Rezaei Sharif6Farzaneh Rajabzadeh7Hooriyeh Khoshdel8Hamid Reza Fathi9Hamid Sharifi10HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical SciencesResearch Center for Addiction and High-Risk Behaviors, Psychosocial Health Research Institute, Iran University of Medical SciencesMental Health, Social Health and Addiction Department (MEHSHAD), Ministry of Health and Medical Education (MOHME)Department of Environmental Health Engineering, Faculty of Health, Mashhad University of Medical ScienceMental Health, Social Health and Addiction Department (MEHSHAD), Ministry of Health and Medical Education (MOHME)Khorasan Razavi Management and Planning OrganizationDepartment of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical SciencesMinistry of Education and TrainingMental Health, Social Health and Addiction Department (MEHSHAD), Ministry of Health and Medical Education (MOHME)Department of Epidemiology and Biostatistics, School of Health, Mashhad University of Medical SciencesHIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical SciencesAbstract Background The HIV epidemic in Iran has been largely driven by people who inject drugs (PWID). Although harm reduction services have been implemented in Iran, some PWID still lack access to these services. This programmatic mapping aimed to determine the spatial distribution of hotspots, estimate the number of PWID, and assess the coverage of prevention services to plan optimal service locations in Iran. Methods A cross-sectional key informant-driven mapping and enumeration methodology was used to identify hotspots of illicit drug use in 82 cities across 24 provinces in Iran from August 2020 to March 2021. Results We identified 4,270 active hotspots, of which 3,350 (78.5%) were associated with people who inject drugs (PWID). An estimated 14,737 PWID (92.2% male) were identified, with 261 (1.8%) under 18 years old, 3,643 (24.7%) aged 18–29 years, 10,061 (68.3%) aged 30–59 years, and 775 (5.2%) over 60 years old. Only half of the hotspots for PWID have active programs, with 24% of services overlapping in coverage areas. Under resource limitation with 47% and 93% reduction in the centers and outreach teams, respectively, we can expect just a 14% decline in services, and this would be the optimum decision in the constrained situation. Conclusions This study provides conclusive evidence that the current spatial distribution of harm reduction services for PWID in Iran is inefficient, characterized by significant coverage gaps in high-risk areas alongside costly resource redundancy through service overlap. Strategic consolidation based on spatial optimization can dramatically improve efficiency and access under resource constraints.https://doi.org/10.1186/s12889-025-23558-7People who inject drugsProgrammatic mappingPopulation size estimationHIVHarm reductionIran |
| spellingShingle | Nima Ghalekhani Ahmad Hajebi Ebrahim Ghodusi Behnaz Beygi Toktam Khojasteh Bojnordi Mohammad Farooq Mashhour Fatemeh Rezaei Sharif Farzaneh Rajabzadeh Hooriyeh Khoshdel Hamid Reza Fathi Hamid Sharifi Programmatic mapping and size estimation of people who inject drugs to plan targeted HIV prevention and harm reduction programs in iran, a nationwide study BMC Public Health People who inject drugs Programmatic mapping Population size estimation HIV Harm reduction Iran |
| title | Programmatic mapping and size estimation of people who inject drugs to plan targeted HIV prevention and harm reduction programs in iran, a nationwide study |
| title_full | Programmatic mapping and size estimation of people who inject drugs to plan targeted HIV prevention and harm reduction programs in iran, a nationwide study |
| title_fullStr | Programmatic mapping and size estimation of people who inject drugs to plan targeted HIV prevention and harm reduction programs in iran, a nationwide study |
| title_full_unstemmed | Programmatic mapping and size estimation of people who inject drugs to plan targeted HIV prevention and harm reduction programs in iran, a nationwide study |
| title_short | Programmatic mapping and size estimation of people who inject drugs to plan targeted HIV prevention and harm reduction programs in iran, a nationwide study |
| title_sort | programmatic mapping and size estimation of people who inject drugs to plan targeted hiv prevention and harm reduction programs in iran a nationwide study |
| topic | People who inject drugs Programmatic mapping Population size estimation HIV Harm reduction Iran |
| url | https://doi.org/10.1186/s12889-025-23558-7 |
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