Ghalekhani Nima, Hajebi Ahmad, Ghodusi Ebrahim, Beygi Behnaz, Khojasteh Bojnordi Toktam, Mashhour Mohammad Farooq, Rezaei Sharif Fatemeh, Rajabzadeh Farzaneh, Khoshdel Hooriyeh, Fathi Hamid Reza, Sharifi Hamid
HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
Research Center for Addiction and High-Risk Behaviors, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran.
BMC Public Health. 2025 Jul 10;25(1):2428. doi: 10.1186/s12889-025-23558-7.
The HIV epidemic in Iran has been largely driven by people who inject drugs (PWID). Although harm reduction services have been implemented in Iran, some PWID still lack access to these services. This programmatic mapping aimed to determine the spatial distribution of hotspots, estimate the number of PWID, and assess the coverage of prevention services to plan optimal service locations in Iran.
A cross-sectional key informant-driven mapping and enumeration methodology was used to identify hotspots of illicit drug use in 82 cities across 24 provinces in Iran from August 2020 to March 2021.
We identified 4,270 active hotspots, of which 3,350 (78.5%) were associated with people who inject drugs (PWID). An estimated 14,737 PWID (92.2% male) were identified, with 261 (1.8%) under 18 years old, 3,643 (24.7%) aged 18-29 years, 10,061 (68.3%) aged 30-59 years, and 775 (5.2%) over 60 years old. Only half of the hotspots for PWID have active programs, with 24% of services overlapping in coverage areas. Under resource limitation with 47% and 93% reduction in the centers and outreach teams, respectively, we can expect just a 14% decline in services, and this would be the optimum decision in the constrained situation.
This study provides conclusive evidence that the current spatial distribution of harm reduction services for PWID in Iran is inefficient, characterized by significant coverage gaps in high-risk areas alongside costly resource redundancy through service overlap. Strategic consolidation based on spatial optimization can dramatically improve efficiency and access under resource constraints.
伊朗的艾滋病病毒疫情在很大程度上是由注射毒品者推动的。尽管伊朗已经实施了减少伤害服务，但一些注射毒品者仍然无法获得这些服务。这项规划性绘图旨在确定热点地区的空间分布，估计注射毒品者的数量，并评估预防服务的覆盖范围，以便在伊朗规划最佳服务地点。
2020年8月至2021年3月，采用横断面关键信息提供者驱动的绘图和枚举方法，在伊朗24个省的82个城市中识别非法药物使用热点地区。
我们确定了4270个活跃热点地区，其中3350个（78.5%）与注射毒品者有关。估计共识别出14737名注射毒品者（92.2%为男性），其中18岁以下的有261人（1.8%），18至29岁的有3643人（24.7%），30至59岁的有10061人（68.3%），60岁以上的有775人（5.2%）。只有一半的注射毒品者热点地区有活跃项目，24%的服务覆盖区域重叠。在资源有限的情况下，中心和外展团队分别减少了47%和93%，预计服务只会减少14%，这将是在受限情况下的最佳决策。
本研究提供了确凿证据，表明伊朗目前针对注射毒品者的减少伤害服务的空间分布效率低下，其特点是高风险地区存在显著的覆盖缺口，同时服务重叠导致资源冗余成本高昂。基于空间优化的战略整合可以在资源限制下显著提高效率和可及性。
