Double counting of clients using services in Iran: implications for assessing the reach of harm reduction programs.

BACKGROUND: Many people with high-risk sexual or injection behaviors use harm reduction services with different identities and are therefore counted more than once in client databases. This practice results in inaccurate statistics on the number of clients served and the effective reach of these services. This study aimed to determine the levels of double counting of clients of harm reduction services, including needle and syringe programs, condom distribution, HIV testing and counseling, and methadone maintenance in five cities in Iran. METHODS: Between September and March 2020, our study included 1630 clients, 115 staff of harm reduction centers, and 30 experts in the field of harm reduction in five cities in Iran. Clients of harm reduction services were asked about using harm reduction services multiple times at the same center or at different centers in the last year using different identities. Estimates of double counting derived from client responses were validated by panels of center staff and experts in harm reduction. RESULTS: Synthesizing data from clients, staff, and experts, the final estimates of double counting of clients using harm reduction services were: HIV testing 10% (95% confidence interval [CI] 0-15), needle and syringe programs 17% (95% CI 8.5-20), condom distribution programs 13% (95% CI 3-19), HIV/STI counseling 10% (95% CI 0-16), and methadone maintenance 7% (95% CI 2-10). CONCLUSION: Double counting of clients in harm reduction services in Iran is substantial. Data on clients reach by harm reduction services need to be corrected for double counting to improve program planning, client population size estimation, and efficient resource allocation.

Study on the effect of neem (Azadirachta indica A. juss) leaf extract on the growth of Aspergillus parasiticus and production of aflatoxin by it at different incubation times.

Aflatoxins are secondary metabolites that are produced by toxigenic strains of some Aspergillus species on foods. Neem plant is a known inhibitor of aflatoxin production. We studied the effects of different concentrations of aqueous neem leaf extract on fungal growth and aflatoxin production by Aspergillus parasiticus (NRRL 2999) at different incubation times. The toxigenic fungus was cultured on sucrose low salts medium in the presence of various concentrations of extracts (0.2, 0.8, 3.12, 12.5 and 50% v/v). After shaking incubation of cultures for 2, 4, 6, 8, 10 and 12 days at 28 degrees C, the fungal mycelia was collected and processed for determination of dry weight. Mycelia and culture media were assayed by TLC method to detect aflatoxin B(1) (AFB(1)). The extracts did not have any obvious effect on fungal growth. AFB(1) production in the control samples increased to the maximum level on the 8th day. The inhibition of aflatoxin synthesis by plant extracts was found to be time- and dose-dependent. The maximum inhibitory effect was 80-90% in the presence of 50% concentration that when compared with control samples was significant (P < 0.05). AFB(1) secretion/production ratio in all of control and treated samples, other than 2nd day, approximately stayed and neem had no effect on it.

Morphological alterations in toxigenic Aspergillus parasiticus exposed to neem (Azadirachta indica) leaf and seed aqueous extracts.

The mode of action of the extracts prepared from neem plant i.e., Azadirachta indica on aflatoxin formation in toxigenic Aspergillus species is not well understood. Aflatoxin production by A. parasiticus was suppressed depending on the concentration of the plant aqueous extract (0, 1.56, 3.12, 6.25, 12.5, and 50% v/v) added to the culture media at the time of spore inoculation. Aflatoxin production in fungal mycelia grown for 96 h in culture media containing 50% neem leaf and seed extracts was inhibited by approximately 90 and approximately 65% respectively. Under similar conditions, culture media amended with 1.56% of leaf or seed extract caused approximately 23 and approximately 7% inhibition respectively. Mycelial samples exposed to selected concentrations of the plant extract (1.56 or 50% v/v) collected and processed for morphological studies. Semi-thin longitudinal and cross sections prepared from control (untreated) and treated mycelia (1.56% v/v) revealed that alterations are limited to the vacuolation of the mycelial cytoplasm. Nevertheless, exposure to high concentration i.e., 50% v/v of the extract resulted in vacuolation of the mycelial cytoplasm and vesicle deformation causing attenuation of cell wall at variable intervals. Herniation of the cytoplasmic contents that was protruding from the mycelium was associated with deformation of the mycelium. Some mycelia showed a cleft between the cell wall and cytoplasm. Association of aflatoxin production with morphological changes suggest that probably integrity of the cell barriers particularly cell wall is critical in regulation of aflatoxin production and excretion.