title: Drug preparation, injection, and sharing practices in Tajikistan: a qualitative study in Kulob and Khorog.
abstract: Sharing injection equipment remains an important rout of transmission of HIV and HCV infections in the region of Eastern Europe and Central Asia. Tajikistan is one of the most affected countries with high rates of injection drug use and related epidemics.The aim of this qualitative study was to describe drug use practices and related behaviors in two Tajik cities - Kulob and Khorog.
  
  
  
  Twelve focus group discussions (6 per city) with 100 people who inject drugs recruited through needle and syringe program (NSP) outreach in May 2014. Topics covered included specific drugs injected, drug prices and purity, access to sterile equipment, safe injection practices and types of syringes and needles used. Qualitative thematic analysis was performed using NVivo 10 software.
  
  
  
  All participants were male and ranged in age from 20 to 78 years. Thematic analysis showed that cheap Afghan heroin, often adulterated by dealers with other admixtures, was the only drug injected. Drug injectors often added Dimedrol (Diphenhydramine) to increase the potency of "low quality" heroin. NSPs were a major source of sterile equipment. Very few participants report direct sharing of needles and syringes. Conversely, many participants reported preparing drugs jointly and sharing injection paraphernalia. Using drugs in an outdoor setting and experiencing withdrawal were major contributors to sharing equipment, using non-sterile water, not boiling and not filtering the drug solution.
  
  
  
  Qualitative research can provide insights into risk behaviors that may be missed in quantitative studies. These finding have important implications for planning risk reduction interventions in Tajikistan. Prevention should specifically focus on indirect sharing practices.
authors.affiliation: Addiction Research Center, Alternative Georgia, 14a Nutsubidze Str., Office 2, 0177, Tbilisi, Georgia. dato@altgeorgia.ge.
authors.forename: David
authors.initials: D
authors.lastname: Otiashvili
authors.affiliation: Global Health Research Center of Central Asia, Columbia University, New York, USA.|The Central Asia Program, Institute for European, Russian, and Eurasian Studies, The Eliott School of International Affairs, George Washington University, Washington, DC, USA.
authors.forename: Alisher
authors.initials: A
authors.lastname: Latypov
authors.affiliation: Addiction Research Center, Alternative Georgia, 14a Nutsubidze Str., Office 2, 0177, Tbilisi, Georgia.|Business School, Ilia State University, Tbilisi, Georgia.
authors.forename: Irma
authors.initials: I
authors.lastname: Kirtadze
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Umedjon
authors.initials: U
authors.lastname: Ibragimov
authors.affiliation: RTI International, Research Triangle Park, NC, USA.
authors.forename: William
authors.initials: W
authors.lastname: Zule
mesh_terms: D000328:Adult; D000368:Aged; D004339:Drug Compounding; D055030:Drug Users / Q000523:psychology*; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D016485:Needle Sharing / Q000523:psychology; D036301:Qualitative Research; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000523:psychology*; D013620:Tajikistan; D055815:Young Adult
keywords: Indirect sharing; Infection risks; Injection drug use; Tajikistan