Beiranvand Siavash, Behzadifar Meysam, Aryankhesal Aidin, Ehsanzadeh Seyed Jafar, Behzadifar Masoud
Department of Anesthesiology, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran.
Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
Harm Reduct J. 2025 Jan 7;22(1):3. doi: 10.1186/s12954-024-01137-0.
The global emergence of the Covid-19 pandemic in 2019 posed unprecedented challenges to healthcare systems, disrupting routine services and necessitating swift adaptations. Harm reduction programs, vital for addressing substance use-related health risks, faced unique challenges during the pandemic, impacting vulnerable populations. This study focuses on the repercussions of Covid-19 on harm reduction policies in Iran, specifically examining the distribution of condoms, syringes, and methadone to high-risk individuals attending Triangle Centers.
The study aims to assess the impact of the Covid-19 pandemic on harm reduction services in Iran and provide evidence-based insights for policy adjustments. Using Interrupted Time Series Analysis (ITSA), the research analyzes trends in the distribution of condoms, syringes, and methadone before and after the official declaration of the pandemic in February 2020.
ITSA, a valuable tool for evaluating program impacts, was employed to analyze data collected from Triangle Centers in Lorestan Province, Iran. Monthly records of harm reduction services (condoms, syringes, methadone) from January 2017 to February 2023 were extracted. The pre-intervention period spanned January 2017 to January 2020, with the post-intervention period extending from February 2020 to February 2023. Statistical analyses were conducted using the Newey-West technique, Combi-Huizinga autocorrelation test, and Ordinary Least Squares (OLS) regression, with a significance threshold set at P-value < 0.05.
Following the onset of Covid-19, the level change in condom distribution to high-risk individuals showed a significant decline, decreasing by 2,168.87 units per month (95% CI: -2,405.57 to -1,932.15). Methadone dispensation, crucial for opioid harm reduction, also witnessed a substantial level change, decreasing by 5,007.60 cc per month (95% CI: -6,251.75 to -3,763.45). Additionally, the provision of syringes decreased significantly, with a level change of -601.01 units per month (95% CI: -706.39 to -495.62).
This study reveals significant disruptions in harm reduction services in Iran post-Covid-19, emphasizing the need for targeted interventions. Factors such as fear, stigma, resource reallocation, and logistical challenges contribute to the observed decreases. Policymakers must prioritize sustaining harm reduction services during pandemics, ensuring continuity for vulnerable populations. The findings underscore the importance of proactive policy development and preparedness to prevent delays and inequalities in accessing essential services for individuals with high-risk behaviors. Overall, integrating harm reduction into pandemic planning is crucial for a resilient and equitable health system.
2019年新冠疫情在全球爆发，给医疗系统带来了前所未有的挑战，扰乱了常规服务，迫使其迅速做出调整。减少伤害项目对于应对与药物使用相关的健康风险至关重要，在疫情期间面临着独特的挑战，影响了弱势群体。本研究聚焦于新冠疫情对伊朗减少伤害政策的影响，特别考察了向三角中心的高危个体分发避孕套、注射器和美沙酮的情况。
本研究旨在评估新冠疫情对伊朗减少伤害服务的影响，并为政策调整提供基于证据的见解。通过中断时间序列分析（ITSA），该研究分析了2020年2月疫情正式宣布前后避孕套、注射器和美沙酮分发的趋势。
ITSA是评估项目影响的一项重要工具，用于分析从伊朗洛雷斯坦省三角中心收集的数据。提取了2017年1月至2023年2月减少伤害服务（避孕套、注射器、美沙酮）的月度记录。干预前期为2017年1月至2020年1月，干预后期为2020年2月至2023年2月。使用纽威-韦斯特技术、组合-胡伊津加自相关检验和普通最小二乘法（OLS）回归进行统计分析，显著性阈值设定为P值<0.05。
新冠疫情爆发后，向高危个体分发避孕套的水平变化显著下降，每月减少2168.87单位（95%置信区间：-2405.57至-1932.15）。对减少阿片类药物危害至关重要的美沙酮发放量也出现了大幅水平变化，每月减少5007.60毫升（95%置信区间：-6251.75至-3763.45）。此外，注射器的供应也显著减少，水平变化为每月-601.01单位（95%置信区间：-706.39至-495.62）。
本研究揭示了新冠疫情后伊朗减少伤害服务受到的重大干扰，强调了有针对性干预的必要性。恐惧、污名、资源重新分配和后勤挑战等因素导致了观察到的减少情况。政策制定者必须优先在疫情期间维持减少伤害服务，确保弱势群体能够持续获得服务。研究结果强调了积极制定政策和做好准备的重要性，以防止高危行为个体在获取基本服务方面出现延误和不平等。总体而言，将减少伤害纳入疫情规划对于建立有韧性和公平的卫生系统至关重要。
