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Farhoudi B, Ghalekhani N, Afsar Kazerooni P, Namdari Tabar H, Tayeri K, Gouya MM, SeyedAlinaghi S, Haghdoost AA, Mirzazadeh A, Sharifi H. Cascade of care in people living with HIV in Iran in 2019; how far to reach UNAIDS/WHO targets. AIDS Care 2021; 34:590-596. [PMID: 34180724 DOI: 10.1080/09540121.2021.1944603] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Systematic HIV program evaluation requires looking at all steps of the HIV cascade of care, from diagnosis to treatment outcomes. Our study was carried out to assess the treatment cascade of people living with HIV (PLWH) in Iran in 2019. We used data from the HIV Case Registry System of Iran through December 2019. We estimated the number of PLWH in 2019 by using Spectrum, and then the proportion of them being diagnosed, linked to care, received antiretroviral treatment and suppressed viral load. We estimated that there are 59,314 (UI: 32,685-125,636) PLWH in Iran, of whom 22,054 people (37% of PLWH) were diagnosed. At the end of 2019, of whom, 14,685 (25% of PLWH) people received antiretroviral therapy. Also, of whom 6338 (11% of PLWH) people had viral load suppression by 2019. Our results showed that about one-third of total PLWH were diagnosed, while this defect is somewhat less in children than adults. To reach the 90.90.90 targets Iran needs to developed the current national HIV care guidelines, which recommend best strategies to scale up the case finding and linkage to care among undiagnosed people specifically those who infected by sexual contact in general and key populations as well.
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Affiliation(s)
- Behnam Farhoudi
- Social Determinant of Health research Center, Amiralmomenin Hospital, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Nima Ghalekhani
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Parvin Afsar Kazerooni
- HIV/AIDS Control Office, Center for Communicable Disease, Ministry of Health, Tehran, Iran
| | - Hengameh Namdari Tabar
- HIV/AIDS Control Office, Center for Communicable Disease, Ministry of Health, Tehran, Iran
| | - Katayoun Tayeri
- HIV/AIDS Control Office, Center for Communicable Disease, Ministry of Health, Tehran, Iran
| | | | - SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Ale-Ebrahim J, Janani L, SeyedAlinaghi SA, Farhoudi B, Abbasi-Ghahramanloo A, Sajadipour M, Motevalian SA. Patterns of high-risk behaviors associated with HIV among male prisoners: A latent class analysis. Med J Islam Repub Iran 2020; 34:109. [PMID: 33316009 PMCID: PMC7722948 DOI: 10.34171/mjiri.34.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Indexed: 02/05/2023] Open
Abstract
Background: Acquired Immunodeficiency Syndrome (AIDS) is one of the most important health challenges worldwide. Moreover, the prevalence of the Human Immunodeficiency Virus (HIV) infection differs among Iranian prisoners and the general population. The present study aimed to identify the patterns of HIV-related high-risk behaviors in male prisoners. Methods: In this cross-sectional study, 2832 inmates were examined for HIV-related high-risk behaviors. The required data were collected using a questionnaire on high-risk behaviors, including a history of heterosexual and homosexual intercourse, and a history of drug use disorders. A Latent Class Analysis (LCA) was performed to analyze the obtained data in WinLTA software. Results: Five latent classes were defined for the male prisoners, as follows: low-risk (20%), moderate-risk (23%), Injection Drug Use (IDU) (8%), heterosexual intercourse/methamphetamine use (38%), and high-risk (11%). The LCA results revealed that high-risk sexual behaviors, IDU, and sharing injection equipment in prisons significantly influence the classification. The obtained data suggested that a history of imprisonment was not frequent in class 2 (OR=1.0033, %95CI:0.9936-1.01) and class 4 members (OR=1.0053, %95CI:0.9929-1.0179). However, it was more prevalent in class 3 (OR=1.0164, %95CI:1.0068-1.0262), and 5 (OR=1.0211, %95CI:1.0129-1.0293). Heterosexual contact had the highest prevalence (75%) in this regard. The results showed that the lowest prevalence of high-risk behaviors was associated with morphine use (0.3%). Among illicit drugs, methamphetamine was the most prevalent drug (42%) in the studied subjects. Conclusion: The present study indicated a high prevalence of high-risk sexual behaviors and methamphetamine use in the investigated participants. We observed the co-occurrence of HIV-related high-risk behaviors in male prisoners. Thus, providing safe sex education for prisoners is highly recommended. It is also necessary to pursue care programs about IDU as a key risk factor for HIV transmission in prisons.
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Affiliation(s)
- Jalal Ale-Ebrahim
- Department of Epidemiology, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Janani
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Ahmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Farhoudi
- Social Determinants of Health Research Center, Amir-Almomenin Hospital, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Abbas Abbasi-Ghahramanloo
- Department of Public Health, School of Health, Ardabil University of Medical Sciences, Ardabil, Iran
| | | | - Seyed Abbas Motevalian
- Research Center for Addiction and High-Risk Behaviors (ReCARB), Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
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Hariri S, Sharafkhah M, Alavi M, Roshandel G, Fazel A, Amiriani T, Motamed-Gorji N, Bazazan A, Merat S, Poustchi H, Malekzadeh R. A simple risk-based strategy for hepatitis C virus screening among incarcerated people in a low- to middle-income setting. Harm Reduct J 2020; 17:56. [PMID: 32795371 PMCID: PMC7427767 DOI: 10.1186/s12954-020-00400-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/28/2020] [Indexed: 12/16/2022] Open
Abstract
Background Hepatitis C virus (HCV) is among the highest priority diseases in custodial settings; however, the diagnosis remains suboptimal among people in custody. This study aimed to validate a short survey for identifying people with HCV infection in a provincial prison in Iran. Methods Between July and December 2018, residents and newly admitted inmates of Gorgan central prison completed a questionnaire, including data on the history of HCV testing, drug use, injecting drug use, sharing injecting equipment, and imprisonment. Participants received rapid HCV antibody testing, followed by venipuncture for RNA testing (antibody-positive only). Each enrollment question (yes/no) was compared with the testing results (positive/negative). Results Overall, 1892 people completed the questionnaire, including 621 (34%) who were currently on opioid agonist therapy (OAT); 30% of participants had been tested for HCV previously. About 71% had a history of drug use, of whom 13% had ever injected drugs; 52% had ever shared injecting equipment. The prevalence of HCV antibody and RNA was 6.9% (n = 130) and 4.8% (n = 90), respectively. The antibody prevalence was higher among people on OAT compared to those with no history of OAT (11.4% vs. 4.0%). History of drug use was the most accurate predictor of having a positive HCV antibody (sensitivity: 95.2%, negative predictive value: 98.9%) and RNA testing (sensitivity: 96.7%, negative predictive value: 99.5%). The sensitivity of the drug use question was lowest among people with no OAT history and new inmates (87% and 89%, respectively). Among all participants, sensitivity and negative predictive value of the other questions were low and ranged from 34 to 54% and 94 to 97%, respectively. Conclusions In resource-limited settings, HCV screening based on having a history of drug use could replace universal screening in prisons to reduce costs. Developing tailored screening strategies together with further cost studies are crucial to address the current HCV epidemic in low- to middle-income countries.
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Affiliation(s)
- Sanam Hariri
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Sharafkhah
- Digestive Disease Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Alavi
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Abdolreza Fazel
- Cancer Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Taghi Amiriani
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Nazgol Motamed-Gorji
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Bazazan
- Department of Health, Golestan State Prisons and Security and Corrective Measures Organization, Gorgan, Iran
| | - Shahin Merat
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Najafi Z, Shekarbeigi S, Koochak HE, Farhoudi B, SeyedAlinaghi S, Mirzazadeh A. HIV and risk behaviors among visitors of inmates at the Great Tehran Prison, Iran, 2018. Open AIDS J 2020; 14:35-40. [PMID: 33654499 DOI: 10.2174/1874613602014010035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Objectives The objective of the present study was to determine the prevalence of HIV and risk behaviors among the inmates' visitors at the Great Tehran Prison in 2018.This population is more likely to be infected with HIV due to their relationship with inmates. However, they have not been prioritized to the other populations in comparison to inmates who are usually prioritized over others. Method Using a convenient sampling method, we recruited inmates' visitorsat the Great Tehran Prison in 2018. An anonymous questionnaire collected information on the participant's demographic characteristics, relationship withinmate, imprisonment history, drug-related risk behaviors, and HIV-related risk behaviors.Rapid HIV blood test detected HIV positive people. To examine the association between risk behaviors and HIV infection, we used a multivariate logistic regression model to calculate the adjusted Odds Ratio (OR)(adjusted Odds ratio of 23.140, 95% CI OD: 1.994-268.5). Results 1131 visitors were asked to participate in the study; out of which 1120 consented (99%).Out of the 1120 participants, 55.2% were female, and the majority (72.4%) aged older than 35 years. Of those who had a sexual partner, 50% did not usea condom in the last 6 months. Overall, HIV prevalence was 0.4% in the inmate visitors, but it was significantly higher among those with a history of drug injection(p=0.003). Conclusion Our findings indicated that overall the HIV prevalence is low amonginmates' visitors; Subgroups with a history of injection have high HIV prevalence which needs to beprioritized for HIV screening and treatment.
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Affiliation(s)
- Zeinab Najafi
- Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behavior, Tehran, Iran
| | - Saeede Shekarbeigi
- Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behavior, Tehran, Iran
| | - Hamid Emadi Koochak
- Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behavior, Tehran, Iran
| | - Behnam Farhoudi
- Clinical Research Development Center, Amir-Almomenin Hospital, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behavior, Tehran, Iran
| | - Ali Mirzazadeh
- University of California, University of San Francisco, San Francisco, United States
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Health service provision for disease control among prisoners: a conceptual note. JOURNAL OF HEALTH RESEARCH 2020. [DOI: 10.1108/jhr-04-2019-0068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PurposeThe aim of present study was to integrate vital noncommunicable diseases (coronary artery disease, hypertension, diabetes mellitus and mental health disorders) into Prison-Based Active Health Services Provision (PAHSP).Design/methodology/approachOn Jan 1, 2018, there were 230,000 prisoners in Iran. Timely and systematic detection and diagnosis of chronic health conditions among this population are imperative. The collaboration between healthcare providers in prison and members of the multidisciplinary team of the healthcare community outside prison initiated an active health service provision approach for HIV and tuberculosis (TB). Guidelines for the control of HIV and TB in prison were piloted, and the finalized version was named “Prison-based Active Health Services Provision” (PAHSP), which has been scaled up in 16 of 260 Iranian prisons.FindingThe PAHSP approach emphasizes the importance of early identification of key symptoms and risk factors. This approach provides an opportunity for improved prevention and treatment, enabling prisoners identified at risk or those who have been diagnosed with a target disease to be followed up and receive the appropriate health care.Originality/valueInitiatives such as screening for chronic health conditions coupled with treatment will reduce the burden of chronic illness among prisoners and the broader community, thereby saving on healthcare costs and lives.
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