Background: Iran has a large population of non-injection opioid users potentially at risk of initiation of drug injection. Objective: Weimplementedaqualitative study to characterize the factors facilitating transitionfromnon-injectiondruguse (NIDU) to injection drug use (IDU) and vice versa. Materials and Methods: We conducted 42 in-depth interviews among purposefully selected groups of Injecting and non-Injecting drug users and health workers, in 2011 in Tehran, Iran. The interviews were audio-recorded, transcribed and coded using OpenCode 3. 6 software. Results: The predominant factor for transition from NIDU to IDU was a high level of drug dependence. IDU decreased the cost associated with drug use by several fold in the short-term. The influence of other injectors, either by learning directly from, encouraged by, feeling coerced by, or identifying with a lifestyle was also mentioned as a causal factor in the transition to IDU. Pleasure-seeking or desire to experience an immediate rush were rarely reported; rather, themes of the need to maintain functionality, reduce pain, and overcome financial difficulties emerged. Vein damage and other IDU-related physical health problems, as well as pressure from family were reasons for reverse transition (IDU to NIDU). Conclusions: New harm reduction approaches could focus on blocking the transition from NIDU to injection and promoting the return to less harmful routes of administration.

Background and Objectives: Considering the importance of donor selection process in blood safety, this study aimed at comparison of frequency of intravenous drug use (IDU) among accepted HCV positive blood donors in different regions of Iran. Materials and Methods: This cross sectional-analytical study was conducted on serologically confirmed HCV positive blood donors who referred to blood transfusion centers for counseling all over the country during November 2015 to May 2017. All provinces were classified in three regions. IDU status and demographic specification of participants were analyzed using questionnaires. Chi square, fisher exact and ANOVA with STATA software version 13 were used for statistical analysis. Results: Participants, according to the number of provinces, sample size and geographical proximity to three areas were classified including 76 from North; 105 from West-South and 90 from East-Center individuals with the mean ages of 37. 73 ± 8. 27, 38. 83 ± 8. 80 and 36. 86 ± 8. 63 and history of IDU of 37 (48. 68%), 45 (42. 86%) and 41 (45. 56%), respectively. No significant differences between different regions of the country were found in the frequency of IDU voluntary blood donors with hepatitis C, age, gender, education status, marriage status (p > 0. 05). Conclusions: Approximately half of the voluntary blood donors with hepatitis C were IDUs. The frequency of IDU was similar among donors from different regions of Iran. Considering the fact that studied donors were found eligible in donor selection and donated the blood, though rejected during the screening phase, conducting research on the issue can increase the quality of blood donor selection and blood safety.

Background: Globally, 10 million Injecting drug users (IDUs) are estimated to be HCV-positive, resulting in a prevalence of 67%. We evaluated the previously unassessed HCV infection amongst IDUs in Kosovo. We determined the distribution of HCV genotypes among IDUs in Prishtina, ascertained their phylogenetic relatedness, and investigated the main risk factors associated with the HCV infection. Methods: Samples were obtained from 205 IDUs in Prishtina, Kosovo, during the Biological and Behavioral Surveillance Study (BioBSS). HCV-positive samples were further genotyped and sequenced. The results were linked with epidemiological data obtained in interviews determining the underlying causes of HCV transmission. Results: The majority of the 205 IDUs participating in the BioBSS were men (89. 3%) with a mean age of 36 years and a history of imprisonment, unemployment, and over a decade of injection drug use. Forty-eight percent of the IDUs were positive for anti-HCV antibodies, and HCV RNA was detected in 70 IDUs (70. 7% of the anti-HCV positive IDUs). The following HCV subtypes were detected: subtype 1a (64. 3%), subtype 3a (34. 3%), and subtype 2k (1. 4%). Phylogenetic clustering was evident among 66. 7% of the HCV subtype 1a samples and 71. 4% of the subtype 3a samples. Significant independent predictors for anti-HCV positivity among IDUs were older age, longer duration of drug use, low education level, drug injection in “ shooting galleries” , and imprisonment. Conclusions: In Prishtina, Kosovo, nearly half of the IDUs were determined to be anti-HCV positive and the majority had an active infection. HCV subtype 1a was found to be most prevalent, followed by subtype 3a. Our results emphasize the urgent need for the implementation of harm-reduction programsamongIDUs in Kosovo, specifically treatmentandprevention through needle/syringe exchange programs directed at gathering places, such as shooting galleries.

Objectives: This study aimed to determine the frequency of latent and active TB infection among IDUs.Materials and Methods: In a cross-sectional study between 2008 and 2009, IDUs referred to the methadone maintenance treatment (MMT) centers in Hamedan-Iran, undergone tuberculin skin test (PPD; purified protein derivative) were recruited. The participants with positive results for PPD test (>5 mm and>10 mm in HIV positive and negative cases), undergone other complementary procedures such as chest-X-ray and sputum smear test.Results: Overall, 268 IDUs between 18 and 70 (mean: 34.5 [8.2]) years were included in the study. PPD test had positive findings in 49 cases (18.3%). There was no significant difference of PPD positivity between HIV positive and negative participants (17.7% vs.18.5%). An active TB was found among IDUs.Conclusions: The high prevalence of latent and active TB among IDUs indicates the need for TB screening tests among this population.