title: The effect of on-site and outreach-based needle and syringe programs in people who inject drugs in Kermanshah, Iran.
abstract: BACKGROUND
  Needle and syringe programs (NSPs) are widely used to reduce harms associated with drug injecting. This study assessed the effect of facility-based (on-site services at drop-in centre) and outreach models of NSP on injection risk behaviours.
  
  
  METHODS
  Self-reported data from 455 people who injected drugs (PWID) during 2014 in Kermanshah, Iran, were examined to measure demographic characteristics and risk behaviors. Self-reported and program data were also assessed to identify their main source of injection equipment. Participants were divided into three sub-groups: facility-based NSP users, outreach NSP users and non-users (comparison group). Coarsened exact matching was used to make the three groups statistically equivalent based on age, place of residence, education and income, and groups were compared regarding the proportion of borrowing or lending of syringes/cookers, reusing syringes and recent HIV testing.
  
  
  RESULTS
  Overall, 76% of participants reported any NSP service use during the two months prior to interview. Only 23% (95%CI: 17-27) reported outreach NSP as their main source of syringes. Using facility-based NSP significantly decreased recent syringe borrowing (OR: 0.27, 95%CI: 0.10-0.70), recent syringe reuse (OR: 0.38, 95%CI: 0.23-0.68) and increased recent HIV testing (OR: 2.60, 95%CI: 1.48-4.56). Similar effects were observed among outreach NSP users; in addition, the outreach NSP model significantly reduced the chance of lending syringes (OR: 0.31, 95%CI: 0.15-0.60), compared to facility-based NSP (OR: 1.25, 95%CI: 0.74-2.17).
  
  
  CONCLUSIONS
  These findings suggest that the outreach NSP model is as effective as facility-based NSP in reducing injection risk behaviours and increasing the rate of HIV testing. Outreach NSP was even more effective than facility-based in reducing the lending of syringes to others. Scaling up outreach NSP is an effective intervention to further reduce transmission of HIV via needle sharing.
authors.affiliation: Safety Promotion and Injury Prevention Research Center, Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Seyed Saeed Hashemi
authors.initials: SS
authors.lastname: Nazari
authors.affiliation: Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Noroozi
authors.affiliation: Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Soori
authors.affiliation: School of Advanced Technologies in Medicine (SATM), Tehran University of Medical Sciences (TUMS), Tehran, Iran; Iranian National Center for Addiction Studies (INCAS), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Noroozi
authors.affiliation: Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Yadollah
authors.initials: Y
authors.lastname: Mehrabi
authors.affiliation: Mental Health Research Center, Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Hajebi
authors.affiliation: Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Sharifi
authors.affiliation: National Drug Research Institute, Faculty of Health Sciences, Curtin University, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Higgs
authors.affiliation: Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Global Health Sciences, University of California, San Francisco, CA, USA. Electronic address: ali.mirzazadeh@ucsf.edu.
authors.forename: Ali
authors.initials: A
authors.lastname: Mirzazadeh
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D040261:Harm Reduction; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D016485:Needle Sharing / Q000706:statistics & numerical data; D018671:Needle-Exchange Programs / Q000458:organization & administration* / Q000706:statistics & numerical data; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000150:complications*; D011795:Surveys and Questionnaires
keywords: Injection risk behaviours; Matching; Needle and syringe programs; People who inject drugs