جستجوی مقالات مرتبط با کلیدواژه « harm reduction » در نشریات گروه « پزشکی »

The diversity of the portfolio of pharmaceutical and non-pharmacological services is an undeniable necessity; however, we must remember that the thinking of harm reduction should govern this process. If we only pay attention to the variety of drugs and their different forms, eventually the noble goal of harm reduction will suffer. In an article that Pedersen et al. prepared about the slow-release form of buprenorphine, there are structural and content problems that will be addressed in this article. This article criticizes the rapid change in the provision of harm reduction services and discusses the impact of structural changes in the provision of services and the location of service provision.

Viral hepatitis is increasingly being recognized as a public health problem, requiring special attention. The World Health Organization (WHO) estimated that in 2019, 296 million people globally (3.8%) had chronic hepatitis B virus (HBV) infection, and 58 million people (0.8%) were living with hepatitis C virus (HCV). To add to this, every year, about 1.5 million people are newly infected with either hepatitis B or C viruses. The Global Health Sector Strategy (GHSS) has aimed to eliminate viral hepatitis as a major public health problem by 2030.

We conducted a desk review to identify strategies for preventing viral hepatitis and develop a roadmap to attain the sustainable development goals (SDG) target by 2030 (particularly in low- and middle-income countries). A search was done in PubMed via Medline on 1 December 2022.

The focus has to be on key interventions, including hepatitis B vaccination (part of the routine child immunization along with rescheduling the birth dose to up to 7 days post-term, adult vaccination, for targeted groups like health care providers, rag pickers, waste handlers, and sanitation workers), ensuring safe injection practices and blood transfusion, harm reduction interventions for people who inject drugs (PWID), adequate testing for early diagnosis, and ensuring appropriate treatment.

It is the need of the hour to prioritize key interventions identified in the review for preventing viral hepatitis.

Service providers have tried to reduce harm reduction and objectively improve health and infectious indicators caused by the consumption of illegal drugs for years. However, some disappointment has happened to these people. On the other hand, policymakers and society still need to remember the efforts of harm reduction service providers or have more and higher expectations in this regard. This article looks at the services and achievements of harm reduction from the past to the present. Also, it discusses the new harm reduction methods that align with today’s needs of the global community. Today, a new mission is needed for harm reduction and other goals, such as mediation and human rights issues related to disease and addiction. The undeniable success of harm reduction in curbing and controlling many infectious aspects has caused policymakers and harm reduction service providers to become weak and need clarification. It has plunged harm reduction into a halo of uncertainty. There is a need to give new life to this dynamic thinking by redefining harm reduction.

 It is necessary to study high-risk behaviors among intravenous drug users, as well as the effectiveness of the syringe-needle program to help health officials adopt appropriate health policies in order to promote public health services. Therefore, it is necessary to gather and present up-to-date evidence on the effectiveness of these interventions.

 The study aimed to evaluate a harm-reducing program using a self-report tool before and after implementing an interventional program, consisting of training on low-risk injection methods, sterilization methods for injection devices, reducing the risks of drug abuse and sexual behaviors, HIV and hepatitis B counseling and testing, apportioning sterile syringes, needles, cotton, alcohol, and condoms, offering methadone maintenance treatment, collecting and discarding contaminated needles, and referral of patients to specialized medical centers. These procedures were performed in two drop-in centers (DIC) in Hamadan. Participants were recruited by the census, including 188 volunteers from the DICs. Descriptive statistics for quantitative variables were mean and standard deviation. Absolute and relative frequencies were used for ranked and categorized variables. Analytical analysis for high-risk behaviors before and after the intervention was performed using the tests related to paired data and, if necessary, regression models (P ≤ 0.05). STATA version 12 was used to analyze the data.

 A total of 188 people participated in this study, of whom 112 (59.6%) were male, and 76 (40.4%) were female. The mean ± standard deviation of the age of the participants was 47.72 ± 10.88. The results showed that the proportions of non-injecting drug users (P = 0.03), injecting drug users (P = 0.008), and co-injection users (P < 0.001) were significantly different compared before admission to the DICs and two months after discharge (P = 0.03).

 Programs of DICs, especially educational programs and distributing syringes and needles, play a significant role in reducing high-risk behaviors, at least in the short term. As a result, this practice may help reduce the incidence of HIV and other diseases transmitted through joint injections among drug users.

Drug addiction is one of the great challenges in human societies, it has many hidden and visible dimensions and angles, therefore, this issue can be considered from different aspects.

This study aimed to compare the effectiveness of short-term cognitive-behavioral group therapy and brief intervention on the mental health dimensions of addicts covered by harm reduction centers in Ahvaz.

This research was a quasi-experimental study with pre-test, post-test, and follow-up stages. From two harm reduction centers in Ahvaz, a simple center was randomly selected. After sampling and estimating the sample size, 80 people were selected and the study groups were divided into three groups (two experimental groups and one control group) in a simple random manner. A general health questionnaire was used to collect data. Data were analyzed by repeated measure analysis of variance with SPSS.22 and a significance level of less than 0.05 was considered.

The results showed that cognitive-behavioral group therapy and brief intervention had no significant effect on physical symptoms and social functioning, but cognitive-behavioral group therapy and brief intervention had a significant effect on anxiety (P<0.001) and depression (P<0.001). Comparison of means shows that brief intervention is more effective than cognitive-behavioral group therapy (P<0.001).

It can be concluded that two cognitive-behavioral group therapies and brief interventions were effective in improving the mental health of addicts under the auspices of harm reduction centers in Ahvaz.

For decades, harm reduction programs for addiction have been started in Iranian prisons. The programs comprise methadone maintenance treatment, antiretroviral treatment, and other harm reduction programs implemented as a triangular clinic. Despite the lack of funding to provide mental health services, particularly for substance use and harm reduction in prisons of low- and middle-income countries, Iran provides well-developed services.

The study investigated the implementation and achievements of harm reduction programs in Sanandaj prison located in the center of Kurdistan Province, west of Iran.

This was a qualitative cross-sectional study. We used various information sources such as a checklist and group discussions. The participants were chosen by the purposive sample method and included prison authorities and harm reduction service providers and recipients. The data were analyzed by content analysis. The MAXQDA 12 software was used to manage the data.

The harm reduction programs included opioid substitution therapy, providing information and education, voluntary counseling and testing for blood-borne diseases, providing condoms, hepatitis C virus screening, and antiretroviral treatment. Following the implementation of the program, a significant decrease in violence, self-injury, illegal drug use and shared syringes, HIV-positive new comers, and no necessity for the needle and syringe program when starting methadone treatment was reported.

Commitment to a strict ban on the entering of drugs to the prison is a reason for the use of high-risk methods of drug use and behaviors such as injection, self-injury, or violence. Sharing syringes and needles is a major cause of the transmission of HIV and hepatitis viruses among drug users. Harm reduction programs, especially methadone maintenance treatment and antiretroviral treatment, have reduced a large proportion of drug-related harms in prisons. Scaling up the programs and their extension to post-release treatment will greatly reduce the country's health costs.
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Methamphetamine (MA) use disorder is a new health problem among Iranian female methadone patients that needs special treatment and rehabilitation services. However, few describe their baseline characteristics, their reasons for MA use while in treatment, and their treatment needs and success. The study aimed at investigating these research gaps.

The participants were 70 women with MA use disorder in two large women-only methadone treatment services in Tehran, Iran. A researcher-made checklist, the Severity of Dependence Scale, the Contemplation Ladder, and the General Health Questionnaire-28 were completed by women in a baseline interview.

The mean±SD age of the participants was 35.84±8.62 years. The participants reported high severity of MA dependence (mean±SD = 6.88±3.19), poor motivation to change (mean±SD = 4.0±2.31]), and impaired psychological well-being (mean±SD = 16.35±4.04) in the treatment. The most important reasons for MA use while undergoing methadone treatment included self-treatment (55%) and pleasure-seeking (43%). The most important MA treatment needs included effective psychological treatments (75%), continued family support (72%), and life skills (68%). Stable living and financial conditions (90%), drug-free living and working places (86%), continued family support (78%), and psychological counseling (69%) were the most important reported factors associated with MA treatment success.

The current study indicated that participants reported a number of MA-related problems. This issue needed a comprehensive treatment program at individual, social, psychological, and professional levels. The findings have important implications for delivering psychosocial treatments, as well as gender-specific research.

Coronavirus disease 2019 (COVID-19) is escalating all over the world and has higher morbidities and mortalities in certain vulnerable populations.  People Who Use Drugs (PWUD) are a marginalized and stigmatized group with weaker immunity responses, vulnerability to stress, poor health conditions, high-risk behaviors, and lower access to health care services. These conditions put them at a higher risk of COVID-19 infection and its complications. In this paper, an international group of experts on addiction medicine, infectious diseases, and disaster psychiatry explore the possible raised concerns in this issue and provide recommendations to manage the comorbidity of COVID-19 and Substance Use Disorder (SUD).

Drug abuse is one of the main problems of human's life; thus communities have been thinkingabout the solution of this problem. The present study aimed to compare the general features of drug abusetreatment policies, war on drugs (WOD), and harm reduction (HR), in the selected countries. The present study was a comparative and desk research that sought to compare context,stewardship, financing, type of substance abuse treatment services, reasons of paradigm shift, and executivechallenges of treatment policies in the selected countries (China, Malaysia, Germany, Netherland, and Iran).The necessary data for comparison of the countries were collected through valid databases, review ofdocuments, and reports of international organizations. Context conditions were better in the HR countries. In most countries, the central governmentplayed a key role in the stewardship, financing, and service providing. In WOD countries, the presence ofjudicial structure was higher in the treatment of drug abuse. The policy-making approach was ideological inWOD countries, but evidence-based in HR countries. It seems that performance of HR countries is better than WOD countries.

Empirical studies show social and psychological supports are pivotal for maintaining physical, psychological, and social health in patients living with HIV/AIDS. The present study aimed at evaluating social and psychological support and the relationship between these two factors among HIV/AIDS patients receiving services form health centers of Zahedan province, south eastern Iran. A cross sectional study was conducted. HIV/AIDS patients, who received services from health care facilities of Zahedan University of Medical Sciences were recruited in the study. Psychological well-being and social support were assessed using the Ryff Scales of Psychological Well-Being and medical outcomes study Social Support Scale (MOS-SSS) questionnaires, respectively. Multivariable linear regression analysis using backward stepwise method was conducted to determine factors related to psychological health and social support. A total 110 patients aged over 16 years old (83 males) were included in the study. Unsafe injecting drug use was the major HIV transmission route (59.1%). Mean psychological health score was significantly higher in males compared to females (P = 0.048). Also, a gender difference was observed for mean social support score, although it was non-significant. The regression analysis showed that females versus males and AIDS patients versus HIV infected patients had lower score of psychological well-being, moreover, social support positively and independently related to the score of psychological well-being (β = -0.505; 95% confidence interval: 0.360 to 0.649). The findings suggest that female patients, those living in the AIDS stage, and those with poor social support are more vulnerable to having lower level of psychological well-being. Harm reduction programs should be reinforced in such groups.

Iranian female methadone patients are at risk of human immunodeficiency virus (HIV) due to involvement in high-risk sexual behaviours and/or needle sharing. The present study aimed to explore the perceived educational needs related to HIV among a group of Iranian female methadone patients. The research design was qualitative and the participants were sampled purposively. Semi-structured interviews were conducted with 34 women and 19 clinicians in Sari, Mashhad, and Tehran, Iran. Then, qualitative content analysis was implemented. The emergence of three major themes and six minor themes was revealed. Women expressed a need to increase their knowledge including women-specific pathophysiology and disease progression and the modes of the virus transmission and prevention. Women also expressed a need to enhance their knowledge and skills related to the physical management of the virus including self-care and reproductive health. Other themes included perceived psychosocial needs including removing stigma and access to resources in the community. Women reported a wide range of educational needs from basic knowledge to advanced skills. The findings can be used in designing women-specific educational programs related to HIV in Iran. Larger studies are suggested with gender-mixed samples in the Persian context

Therapeutic community program (TCP) is available for opioid users in Iran (Persia), the most populous Persian Gulf country. TCP can reduce opioid use and some associated harms. However, there are few studies about TCP in Iran.
The current qualitative study aimed to explore the self-perceived positive and negative aspects of TCP among a group of Persian opioid users in Tehran.
The study was conducted at a large men-only TC center between December 2010 and July 2011. Overall, 50 opioid users were interviewed in eight roundtable meetings. Nine key informants were individually interviewed. NVivo 10 was used to thematically analyze the data.
The mean age of the participants was 38 (SD = 9) years. Participants were dependent on opioids. The thematic data analyses indicated that peer support, group meetings, and the lack of medications were the most frequently self-perceived positive aspects of TCP. Untreated withdrawal symptoms, long duration of residence, anxiety, and depression were the most frequently reported negative aspects of TCP.
The identified positive treatment aspects should be considered to improve the TCP quality. The identified negative treatment aspects should be managed in the provision of TCP.

Infection with hepatitis C virus (HCV) is increasingly recognized as a major global health problem.
The aim of this study was to measure the prevalence of HCV infection and determine the risk factors associated with HCV among male people who inject drugs (PWID) in Kermanshah, Iran.
In this cross sectional study, the samples were recruited from 2 drop-in centers and related community outreach sites, using snowball sampling. The questionnaire consisted of 3 sections, including demographics, drug use patterns, and risky behaviors. HCV infection was tested in venous blood samples, collected from the participants, using the ABON rapid test kit. Logistic regression analysis was used to determine the association between HCV status and the associated factors, reported as odds ratio (OR) and 95% confidence interval (CI).
The mean age of the participants was 36.7 ± 8.5 years (range, 18 - 65 years). Over half of the participants (54.8%) tested positive for HCV antibodies; in other words, they had been exposed to the virus. Adjusted OR for people reporting shared equipments within the past month was 3.36 times higher than the OR of people who reported no shared equipments (P = 0.000). The adjusted OR of positive HCV among those who injected twice or more per day was 4.33 (P = 0.000), compared to those who injected only once a day (or less). With over half the participants having evidence of HCV exposure, there is a need to increase the coverage of harm-reduction programs, especially sterile injection equipment programs. Moreover, increasing access to harm-reduction programs and HCV treatment can ultimately reduce the opportunities for HCV transmission.

The aim of this study was to investigate the effectiveness of the harm reduction group therapy based on Bandura's self-efficacy theory on risky behaviors of sex workers in Kerman, Iran.
A quasi-experimental two-group design (a random selection with pre-test and post-test) was used. A risky behaviors questionnaire was used to collect. The sample was selected among sex workers referring to drop-in centers in Kerman. Subjects were allocated to two groups and were randomly classified into two experimental and control groups. The sample group consisted of 56 subjects. The experimental design was carried out during 12 sessions, and the post-test was performed one month and two weeks after the completion of the sessions. The results were analyzed statistically.
Findings: By reducing harm based on Bandura's self-efficacy theory, the risky behaviors of the experimental group, including injection behavior, sexual behavior, violence, and damage to the skin, were significantly reduced in the pre-test compared to the post-test (P The harm reduction group therapy based on Bandura's self-efficacy theory can reduce the risky behaviors of sex workers.

Methamphetamine as one of the most prevalent drugs can reduce the efficacy of interventions designed to reduce HIV prevalence such as opioid substitution therapy and other harm reduction interventions. Harm reduction facilities and interventions have mainly been designed for opioid users, but due to the high prevalence of methamphetamine use among the clients, these settings could be appropriate entry points for providing methamphetamine focused harm reduction interventions.
The present study aimed at examining the effects of the integration of a methamphetamine harm reduction intervention into opioid harm reduction services of drop in centers (DICs) on the high- risk behaviors of the participants.
This prospective study was conducted to evaluate changes in high- risk behaviors associated with methamphetamine use among regular methamphetamine user clients of 10 DICs located in provincial capitals of Iran from September 2014 to March 2015. Participants were evaluated before and after a manual based psychoeducation intervention.
In total, 357 clients (18.5% females, and 81.5% males) entered the study; of whom, 60.3% of males and 83.3% of females were daily methamphetamine users at initial assessment. The prevalence of injection in the last 3 months was 8% and 1.6% among male and female participants, respectively. The frequency of sexual intercourse among participants had a significant reduction after intervention. The use of a condom in the last intercourse was increased significantly, moreover, having sexual intercourses without condom under the influence of methamphetamine was reduced, especially among females.
The results of the present study provide provisional data on the effectiveness of stimulant harm reduction among clients of DICs in Iran. In addition, our findings revealed that service providers believe that this integration is feasible and the clients found it acceptable. Conducting studies with more rigorous design and longer follow-up is highly recommended.

Alcohol use is a health concern in Iran, the most populated Persian Gulf country. However, alcohol use disorder treatment is a new issue in Iran, which needs consideration.
In this article, we present a study protocol that aims to investigate the feasibility and effectiveness of integration of outpatient alcohol use disorder treatment in drug treatment centers in Iran.
The study design is a prospective cohort and multi-center research, which will be conducted in major cities of Iran in 2016 - 2017. Overall, 750 participants with psychiatric diagnosis of hazardous alcohol drinking or dependence will be recruited. The settings will be 150 outpatient drug treatment centers. This project will be implemented in 3 phases. Phase I will be the preparation phase, Phase II will focus on training treatment providers and Phase III will be the main phase of the study and will evaluate the feasibility and effectiveness of integration of alcohol use disorder treatment services within outpatient network of drug treatment centers. Five questionnaires will be used to assess the study outcomes. Completing the study questionnaires at baseline, weeks 4, 12, 24, and 52 will assess participants. Data analyses, including descriptive statistics, regression models, and repeated measures of ANOVA will be performed using SPSS version 22.
This is the first study to investigate the feasibility and effectiveness of integration of outpatient alcohol use disorder treatment in drug treatment centers in Iran. If found effective, the results of this study will be useful for applying in Iran and other countries in Western and Central Asia.