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Reekie A, Gratrix J, Smyczek P, Woods D, Poshtar K, Courtney K, Ahmed R. A Cross-Sectional, Retrospective Evaluation of Opt-Out Sexually Transmitted Infection Screening at Admission in a Short-Term Correctional Facility in Alberta, Canada. JOURNAL OF CORRECTIONAL HEALTH CARE 2022; 28:429-438. [PMID: 36475978 DOI: 10.1089/jchc.21.08.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Incarcerated populations experience higher rates of sexually transmitted infections (STIs) than the general population, alongside inconsistent testing strategies. In response, universal opt-out STIs (chlamydia, gonorrhea, syphilis, and HIV) screening was implemented at admission in a short-term correctional facility in Alberta, Canada, for individuals ≤35 years. A cross-sectional, retrospective evaluation of testing outcomes between March 2018 and February 2020 was completed. Descriptive statistics were used to stratify STIs by gender, age group, and date for univariate analysis. Despite low uptake (31.2%), opt-out screening resulted in high positivity rates (14.9%, 10.8%, 29.5%, and 0.3%, respectively) and treatment completion (93.7%) while capturing a high proportion (52.6%) of asymptomatic cases. Opt-out screening at admission is feasible and can improve STI testing in high-risk individuals experiencing incarceration in Canada.
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Affiliation(s)
- Alexandra Reekie
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jennifer Gratrix
- Department of STI Services, Alberta Health Services-Provincial STI Program, Edmonton, Alberta, Canada
| | - Petra Smyczek
- Department of STI Services, Alberta Health Services-Provincial STI Program, Edmonton, Alberta, Canada
| | - Dan Woods
- Department of Corrections, Alberta Health Services-Corrections Health, Edmonton, Alberta, Canada
| | - Katherine Poshtar
- Department of Corrections, Alberta Health Services-Corrections Health, Edmonton, Alberta, Canada
| | - Keith Courtney
- Department of Corrections, Alberta Health Services-Corrections Health, Edmonton, Alberta, Canada
| | - Rabia Ahmed
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Harawa NT, Brewer R, Buckman V, Ramani S, Khanna A, Fujimoto K, Schneider JA. HIV, Sexually Transmitted Infection, and Substance Use Continuum of Care Interventions Among Criminal Justice-Involved Black Men Who Have Sex With Men: A Systematic Review. Am J Public Health 2019; 108:e1-e9. [PMID: 30383433 DOI: 10.2105/ajph.2018.304698] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Because Black men who have sex with men (BMSM) experience high rates of both HIV and incarceration relative to other groups, the various stages of criminal justice involvement may serve as important intervention points for addressing HIV and related conditions in this group. Although systematic reviews of HIV interventions targeting MSM in general and BMSM in particular exist, no review has explored the range and impact of HIV, sexually transmitted infection (STI), and substance use prevention and care continuum interventions focused on criminal justice-involved (CJI) populations. OBJECTIVES To describe the range and impact of published HIV, STI, and related substance use interventions for US-based CJI populations and to understand their relevance for BMSM. SEARCH METHODS We conducted systematic searches in the following databases: PubMed, MEDLINE, Cochrane, CINAHL, and PsycINFO, covering the period preceding December 1, 2016. SELECTION CRITERIA We selected articles in scientific publications involving quantitative findings for studies of US-based interventions that focused on CJI individuals, with outcomes related to sexual or substance use risk behaviors, HIV, or STIs. We excluded studies if they provided no demographic information, had minimal representation of the population of interest (< 30 African American or Black male or transgender participants), had study populations limited to those aged younger than 18 years, or were limited to evaluations of preexisting programs. DATA COLLECTION AND ANALYSIS We abstracted data from these articles on study design; years covered; study location; participant number, demographics, and sexual orientation (if available); criminal justice setting or type; health condition; targeted outcomes; and key findings. We scored studies by using the Downs and Black quality and bias assessment. We conducted linear regression to examine changes in study quality by publication year. MAIN RESULTS Fifty-eight articles met inclusion criteria, including 8 (13.8%) modeling or cost-effectiveness studies and 13 (22.4%) randomized controlled trials. Just 3 studies (5.2%) focused on sexual or gender minorities, with only 1 focused on BMSM. In most studies (n = 36; 62.1%), however, more than 50% of participants were Black. The most common intervention addressed screening, including 20 empirical studies and 7 modeling studies. Education-focused interventions were also common (n = 15) and usually employed didactic rather than skill-building approaches. They were more likely to demonstrate increases in HIV testing, knowledge, and condom-use intentions than reductions in sex- and drug-risk behaviors. Screening programs consistently indicated cost-effectiveness, including with BMSM. Care continuum interventions for people living with HIV showed mixed results; just 3 involved randomized controlled trials, and these interventions did not show significant differences compared with control conditions. A minority of programs targeted non-custody-based CJI populations, despite their constituting a majority of the CJI population at any given time. AUTHORS' CONCLUSIONS Screening CJI populations for HIV and other STIs is effective and cost-efficient and holds promise for reducing HIV in BMSM. Education-based and care provision interventions also hold promise for addressing HIV, STIs, mental health, and substance use in CJI populations. Additional empirical and modeling studies and results specific to sexual minorities are needed; their paucity represents a disparity in how HIV is addressed. Public Health Implications. HIV and STI screening programs focused on CJI populations should be a priority for reducing HIV risk and numbers of undiagnosed infections among BMSM. Funding agencies and public health leaders should prioritize research to improve the knowledge base regarding which care continuum intervention approaches are most effective for BMSM with criminal justice involvement. Developments in modeling approaches could allow researchers to simulate the impacts and costs of criminal justice involvement-related interventions that might otherwise be cost, time, or ethically prohibitive to study empirically.
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Affiliation(s)
- Nina T Harawa
- Nina T. Harawa is with the Department of Medicine, David Geffen School of Medicine, University of California Los Angeles. At the time of the study, Russell Brewer was with the HIV/STI Portfolio, Louisiana Public Health Institute, New Orleans. Victoria Buckman is with The Chicago Center for HIV Elimination, University of Chicago, Chicago, IL. Santhoshini Ramani, Aditya Khanna, and John A. Schneider are with the Department of Medicine, University of Chicago. Kayo Fujimoto is with the Division of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston
| | - Russell Brewer
- Nina T. Harawa is with the Department of Medicine, David Geffen School of Medicine, University of California Los Angeles. At the time of the study, Russell Brewer was with the HIV/STI Portfolio, Louisiana Public Health Institute, New Orleans. Victoria Buckman is with The Chicago Center for HIV Elimination, University of Chicago, Chicago, IL. Santhoshini Ramani, Aditya Khanna, and John A. Schneider are with the Department of Medicine, University of Chicago. Kayo Fujimoto is with the Division of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston
| | - Victoria Buckman
- Nina T. Harawa is with the Department of Medicine, David Geffen School of Medicine, University of California Los Angeles. At the time of the study, Russell Brewer was with the HIV/STI Portfolio, Louisiana Public Health Institute, New Orleans. Victoria Buckman is with The Chicago Center for HIV Elimination, University of Chicago, Chicago, IL. Santhoshini Ramani, Aditya Khanna, and John A. Schneider are with the Department of Medicine, University of Chicago. Kayo Fujimoto is with the Division of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston
| | - Santhoshini Ramani
- Nina T. Harawa is with the Department of Medicine, David Geffen School of Medicine, University of California Los Angeles. At the time of the study, Russell Brewer was with the HIV/STI Portfolio, Louisiana Public Health Institute, New Orleans. Victoria Buckman is with The Chicago Center for HIV Elimination, University of Chicago, Chicago, IL. Santhoshini Ramani, Aditya Khanna, and John A. Schneider are with the Department of Medicine, University of Chicago. Kayo Fujimoto is with the Division of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston
| | - Aditya Khanna
- Nina T. Harawa is with the Department of Medicine, David Geffen School of Medicine, University of California Los Angeles. At the time of the study, Russell Brewer was with the HIV/STI Portfolio, Louisiana Public Health Institute, New Orleans. Victoria Buckman is with The Chicago Center for HIV Elimination, University of Chicago, Chicago, IL. Santhoshini Ramani, Aditya Khanna, and John A. Schneider are with the Department of Medicine, University of Chicago. Kayo Fujimoto is with the Division of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston
| | - Kayo Fujimoto
- Nina T. Harawa is with the Department of Medicine, David Geffen School of Medicine, University of California Los Angeles. At the time of the study, Russell Brewer was with the HIV/STI Portfolio, Louisiana Public Health Institute, New Orleans. Victoria Buckman is with The Chicago Center for HIV Elimination, University of Chicago, Chicago, IL. Santhoshini Ramani, Aditya Khanna, and John A. Schneider are with the Department of Medicine, University of Chicago. Kayo Fujimoto is with the Division of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston
| | - John A Schneider
- Nina T. Harawa is with the Department of Medicine, David Geffen School of Medicine, University of California Los Angeles. At the time of the study, Russell Brewer was with the HIV/STI Portfolio, Louisiana Public Health Institute, New Orleans. Victoria Buckman is with The Chicago Center for HIV Elimination, University of Chicago, Chicago, IL. Santhoshini Ramani, Aditya Khanna, and John A. Schneider are with the Department of Medicine, University of Chicago. Kayo Fujimoto is with the Division of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston
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Poteat TC, Malik M, Beyrer C. Epidemiology of HIV, Sexually Transmitted Infections, Viral Hepatitis, and Tuberculosis Among Incarcerated Transgender People: A Case of Limited Data. Epidemiol Rev 2018; 40:27-39. [PMID: 29554240 PMCID: PMC5982724 DOI: 10.1093/epirev/mxx012] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 11/13/2022] Open
Abstract
Transgender people experience a disproportionate burden of human immunodeficiency virus (HIV) and incarceration. Discrimination, victimization, poverty, and poor mental health drive vulnerability to HIV and related infections, as well as risk of arrest, detention, and incarceration. In this paper, we systematically review published data on HIV, sexually transmitted infections, viral hepatitis, and tuberculosis among incarcerated transgender people; describe potential structural determinants of HIV risk and transmission; identify gaps in the literature; and make recommendations for research and interventions to address this neglected population. We found that HIV and related infections among incarcerated transgender people have received little attention in the epidemiologic literature. The limited data available, which date from 1992, demonstrate high prevalence of HIV and sexually transmitted infections in this population internationally. Transgender people who had not had genital surgery were typically placed in jails and prisons corresponding to birth-assigned sex rather than gender identity. Once incarcerated, they routinely faced harassment, physical abuse, and sexual violence from inmates and staff and denial of access to medically necessary gender-affirming therapies. More HIV research with incarcerated transgender populations is urgently needed to inform correctional policy change that centers human rights and structural interventions, such as stigma reduction, pre-arrest diversion, and access to HIV prevention methods and gender-affirming care during incarceration.
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Affiliation(s)
- Tonia C Poteat
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Mannat Malik
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Chris Beyrer
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Tavoschi L, Vroling H, Madeddu G, Babudieri S, Monarca R, Vonk Noordegraaf-Schouten M, Beer N, Gomes Dias J, O’Moore É, Hedrich D, Oordt-Speets A. Active Case Finding for Communicable Diseases in Prison Settings: Increasing Testing Coverage and Uptake Among the Prison Population in the European Union/European Economic Area. Epidemiol Rev 2018; 40:105-120. [PMID: 29648594 PMCID: PMC5982719 DOI: 10.1093/epirev/mxy001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 12/15/2017] [Accepted: 12/15/2017] [Indexed: 12/16/2022] Open
Abstract
Prison populations are disproportionally affected by communicable diseases when compared with the general community because of a complex mix of socioeconomic determinants and environmental factors. Tailored and adequate health care provision in prisons has the potential to reach vulnerable and underserved groups and address their complex needs. We investigated the available evidence on modalities and effectiveness of active case-finding interventions in prisons by searching PubMed, Embase, and the Cochrane Library for records on prison and active case finding with no language limit. Conference abstracts and unpublished research reports also were retrieved. We analyzed the findings by testing modality, outcomes, and study quality. The included 90 records-63 peer-reviewed, 26 from gray literature, and 1 systematic review-reported variously on viral hepatitis, human immunodeficiency virus, sexually transmitted infections, and tuberculosis. No records were retrieved for other communicable diseases. Provider-initiated opt-in testing was the most frequently investigated modality. Testing at entry and provider-initiated testing were reported to result in comparatively higher uptake ranges. However, no comparative studies were identified that reported statistically significant differences between testing modalities. Positivity rates among tested inmates ranged broadly but were generally high for all diseases. The evidence on active case finding in correctional facilities is limited, heterogeneous, and of low quality, making it challenging to draw conclusions on the effect of different testing modalities. Scale-up of provider-initiated testing in European correctional facilities could substantially reduce the undiagnosed fraction and, hence, prevent additional disease transmission in both prison settings and the community at large.
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Affiliation(s)
- Lara Tavoschi
- Surveillance and Response Unit, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Hilde Vroling
- Pallas, Health Research and Consultancy B.V., Rotterdam, the Netherlands
| | - Giordano Madeddu
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Sergio Babudieri
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Roberto Monarca
- Health Without Barriers – European Federation for Prison Health, Viterbo, Italy
| | | | - Netta Beer
- Surveillance and Response Unit, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Joana Gomes Dias
- Surveillance and Response Unit, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Éamonn O’Moore
- Department of Health & Justice, Public Health England, London, UK
| | - Dagmar Hedrich
- Public Health Unit, European Monitoring Centre on Drugs and Drug Addiction, Lisbon, Portugal
| | - Anouk Oordt-Speets
- Pallas, Health Research and Consultancy B.V., Rotterdam, the Netherlands
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5
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Lindbom SJA, Larsson M, Agardh A. The naked truth about HIV and risk taking in Swedish prisons: A qualitative study. PLoS One 2017; 12:e0182237. [PMID: 28759572 PMCID: PMC5536296 DOI: 10.1371/journal.pone.0182237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 07/12/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This qualitative study explores former prison inmates' perceptions and attitudes towards HIV risk inside Swedish prisons. METHOD In 2014, eight semi-structured interviews were conducted with former male prisoners to gain a deeper understanding of situations perceived to be associated with risk of HIV transmission. The material gathered from the interviews was analyzed by manifest and latent qualitative content analysis. RESULTS The findings revealed that risky behavioral practices, such as sharing needles, unprotected sexual activity, and lack of openness about HIV status represented potential health threats with regard to the risk of HIV transmission. CONCLUSIONS Evidence from the study indicates that educational interventions regarding HIV and the transmission routes are required for HIV prevention in Swedish prisons.
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Affiliation(s)
- Sigrid J. A. Lindbom
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Markus Larsson
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
- * E-mail:
| | - Anette Agardh
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
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6
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Akbari M, Akbari M, Naghibzadeh-Tahami A, Joulaei H, Nasiriyan M, Hesampour M, Bagheri-Lankarani K. Prevalence of HIV/AIDS among Iranian Prisoners: A Review Article. ADDICTION & HEALTH 2016; 8:195-206. [PMID: 28496958 PMCID: PMC5422016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/21/2016] [Indexed: 10/31/2022]
Abstract
BACKGROUND Worldwide, prisoners are more at risk of being infected by human immunodeficiency virus (HIV) as well as hepatitis C and B in comparison with other risk groups. The combination of acquired immune deficiency syndrome (AIDS), addiction and prison are factors that threaten the health of our society. Influence of risky behaviors is so common on transmission of AIDS into prisoners' bodies. This study used available information and reports to investigate the prevalence of HIV in Iranian prisons. METHODS The following review of documents available in national and foreign databases, a total of 26 studies were investigated and required information was extracted from both the full papers and abstracts. FINDINGS The selected studies differed methodologically in their sampling method and data collection tools. Within the 26 studies analyzed, there was a combined study cohort of 39707 people in whom HIV prevalence varied between 0% and 24.40%. CONCLUSION In this study, HIV prevalence ranged widely among the prisoners, and in most of these studies, the rate in Iran was higher than that of other countries. The prevalence of disease was highest among intravenous drug users. Unless proper preventive and control plans among risk groups such as prisoners are not implemented in a timely and suitable manner, the risk of infection in the broader society will increase.
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Affiliation(s)
- Morteza Akbari
- Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Akbari
- PhD Student, Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Naghibzadeh-Tahami
- PhD Student, Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hassan Joulaei
- Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Nasiriyan
- Assistant Professor, Department of Biostatistic and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Hesampour
- Department of Health Education and Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Bagheri-Lankarani
- Professor, Health Policy Research Center AND Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Shaikh RA, Simonsen KA, O'Keefe A, Earley M, Foxall M, Islam KM, Person A, Boyle C, Sandkovsky U, Margalit R. Comparison of Opt-In Versus Opt-Out Testing for Sexually Transmitted Infections Among Inmates in a County Jail. JOURNAL OF CORRECTIONAL HEALTH CARE 2015; 21:408-16. [PMID: 26285597 DOI: 10.1177/1078345815600447] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A majority of jails in the United States rely on an opt-in (voluntary) rather than opt-out (universal) approach to testing for sexually transmitted infections (STIs). This study compares an opt-out approach at intake to opt-in testing during incarceration and estimates the prevalence of common STIs among jail inmates. Data derive from a universal intake pilot testing program (n = 298) and an established, student-led voluntary testing program (n = 1,963), respectively. The adjusted prevalence as well as the odds of testing positive for chlamydia were significantly higher in the opt-out program (p = .025 and .008, respectively) than the opt-in program but not for gonorrhea (p = .402 and .300, respectively). These results demonstrate the potential public health benefit of implementation of universal STI testing of jail inmates.
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Affiliation(s)
- Raees A Shaikh
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kari A Simonsen
- Department of Pediatrics, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - Anne O'Keefe
- Douglas County Health Department, Omaha, NE, USA
| | - Mary Earley
- Douglas County Department of Corrections, Omaha, NE, USA
| | - Mark Foxall
- Douglas County Department of Corrections, Omaha, NE, USA
| | - K M Islam
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Austin Person
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Cole Boyle
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Uriel Sandkovsky
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ruth Margalit
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
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Haghdoost AA, Mirzazadeh A, Shokoohi M, Sedaghat A, Gouya MM. HIV trend among Iranian prisoners in 1990s and 2000s; analysis of aggregated data from HIV sentinel sero-surveys. Harm Reduct J 2013; 10:32. [PMID: 24257447 PMCID: PMC3842738 DOI: 10.1186/1477-7517-10-32] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 11/16/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Using the aggregated data of all sentinel sero-surveys (1991 to 2007), this study aimed to report the HIV trend among Iranian prisoners. METHOD Overall, we analysed the aggregated data from 397 HIV sero-surveys conducted in 72 prisons (included 155,771 prisoners) from 1991 through 2007. RESULTS The overall HIV prevalence was 2.8% (95% CI: 1.8%-4.3%). In 1998, HIV prevalence dramatically increased to 4.5% (95% CI: 1.1%-16.8%), which later became stable at level of 2.8%. Prisons were so heterogeneous regarding HIV prevalence (0% to 13.2%). CONCLUSION Since the outbreak, the ministry of health has acknowledged prisoners as one of the high-risk groups for HIV, increased the number of sentinel surveys and on-site harm reduction services to better monitor and response to the HIV epidemic. The downward trend of HIV prevalence after 2005 suggests the effectiveness of such interventions which need to be continued.
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Affiliation(s)
- Ali-Akbar Haghdoost
- Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Mirzazadeh
- Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Mostafa Shokoohi
- Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Abbas Sedaghat
- Ministry of Health & Medical Education, CDC, Tehran, Iran
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