Noroozi Mehdi, Noroozi Alireza, Sharifi Hamid, Harouni Gholamreza Ghaedamini, Marshall Brandon D L, Ghisvand Hesam, Qorbani Mostafa, Armoon Bahram
Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
Department of Neuroscience and Addiction, School of Advanced Technologies in Medicine, University of Medical Sciences, Tehran, Iran.
Int J Behav Med. 2019 Feb;26(1):50-58. doi: 10.1007/s12529-018-9758-4.
Many studies have found significant differences in HIV risk at the community and socioeconomic levels. However, few have considered variations in needle and syringe program (Jin et al., Oral Dis. 1;22(7):609-19) coverage and other community characteristics on HIV risk behaviors among people who inject drugs (PWIDs). Our objective was to study the relationship between individual factors and city-level characteristics (such as the city's coverage of harm reduction programs) on HIV risk behavior among PWID residing in two cities in Iran.
The study was conducted from March to August 2016 in Tehran and Kermanshah provinces. One thousand PWID were recruited by a convenience sampling recruitment at local NSP Drop-in Centers (DIC) and through "snowball sampling" (i.e., using peers to refer participants to the study). We first examined associations between individual-level variables and HIV risk behaviors in bivariate analysis using the chi-square or Fisher's exact tests, as appropriate. Next, multi-level models were constructed to determine the amount of variability in HIV risk behavior that could be accounted for by individual- and community-level characteristics. Variables with p value < 0.2 were included in the multiple logistic regression model.
The results of the multilevel modeling showed that 32% of the variability in HIV risk behaviors among PWID could be explained by factors that differed between the two cities. When individual factors including higher HIV knowledge, access to NSP, higher HIV risk perception, and methamphetamine use were all included in the final model, 22% of the variability in HIV risk behaviors could be explained to city-level variables.
Findings suggest that expanding the accessibility (i.e., hours and venues) and community-level coverage of NSP services by establishing programs where PWID congregate might reduce HIV risk behavior among PWID.
许多研究发现，在社区和社会经济层面，艾滋病病毒（HIV）感染风险存在显著差异。然而，很少有研究考虑到针头和注射器项目（Jin等人，《口腔疾病》1；22(7):609 - 19）覆盖率的差异以及其他社区特征对注射吸毒者（PWID）的HIV风险行为的影响。我们的目的是研究伊朗两个城市中PWID的个体因素与城市层面特征（如城市减少伤害项目的覆盖率）之间对HIV风险行为的关系。
该研究于2016年3月至8月在德黑兰省和克尔曼沙阿省进行。通过在当地针头和注射器项目（NSP）的服务点（DIC）采用便利抽样招募以及通过“滚雪球抽样”（即利用同伴将参与者推荐到研究中）的方式招募了1000名PWID。我们首先在双变量分析中使用卡方检验或费舍尔精确检验（视情况而定）来检验个体层面变量与HIV风险行为之间的关联。接下来，构建多层次模型以确定个体和社区层面特征能够解释的HIV风险行为的变异性数量。p值<0.2的变量被纳入多元逻辑回归模型。
多层次建模结果表明，PWID中HIV风险行为32%的变异性可由两个城市之间不同的因素来解释。当将包括较高的HIV知识、获得NSP服务、较高的HIV风险认知以及使用甲基苯丙胺等个体因素都纳入最终模型时，HIV风险行为22%的变异性可由城市层面变量来解释。
研究结果表明，通过在PWID聚集的地方设立项目来扩大NSP服务的可及性（即服务时间和场所）以及社区层面的覆盖率，可能会降低PWID中的HIV风险行为。
