Comparing profile of people who inject drugs (PWID) accessing different types of needle and syringe programs or secondary distribution in Kermanshah, Iran

Background: Needle and syringe programs (NSPs) have been developed and implemented since 2002 in Iran. NSPs are largely delivered through fixed site and outreach services. Characterizing people who inject drugs (PWID) primarily using different sources of injecting equipment can help service design. Objective: The objective of the present study was to characterize and compare the risk behaviors of PWID according to their primary sources of clean needles and syringes in Kermanshah, Iran. Methods: We used data from a cross-sectional study of 500 PWID in Kermanshah. Behavioral and program data were also assessed to identify their main source of injection equipment, demographic characteristics, and risk behaviors. The Cochran-Armitage trend test was used to test for trends in characteristics and risk behaviors among the three sources for clean needles. We also ran a multinomial logistic regression to assess the individual characteristics of those who have reported the outreach or other sources of NSP over fixed sites as their main sources of clean needles and syringe. Results: As reported by study participants, their three main sources were fixed sites (n = 230, 46%), (n = 180, 36%) and secondary distribution ((n = 90, 18%). The odds of reporting outreach versus fixed site as main source was significantly higher in those with unstable housing (AOR = 2.8, p = 0.01), who started injection under 25 years of age (AOR = 2.7, p = 0.03), and who have longer duration of injections (AOR = 2.3, p = 0.02). Similarly, the odds of reporting secondary distribution versus fixed site as main source of needles and syringes was significantly higher in those with unstable housing (AOR = 3.2, p = 0.01). Conclusions: We observed a trend toward more risky injection behaviors among the users of fixed sites to outreach program users and then those who have reported other alternates as main sources. This can be explained by insufficient coverage of injections.