The HepTestContest: a global innovation contest to identify approaches to hepatitis B and C testing.

BACKGROUND: Innovation contests are a novel approach to elicit good ideas and innovative practices in various areas of public health. There remains limited published literature on approaches to deliver hepatitis testing. The purpose of this innovation contest was to identify examples of different hepatitis B and C approaches to support countries in their scale-up of hepatitis testing and to supplement development of formal recommendations on service delivery in the 2017 World Health Organization hepatitis B and C testing guidelines. METHODS: This contest involved four steps: 1) establishment of a multisectoral steering committee to coordinate a call for contest entries; 2) dissemination of the call for entries through diverse media (Facebook, Twitter, YouTube, email listservs, academic journals); 3) independent ranking of submissions by a panel of judges according to pre-specified criteria (clarity of testing model, innovation, effectiveness, next steps) using a 1-10 scale; 4) recognition of highly ranked entries through presentation at international conferences, commendation certificate, and inclusion as a case study in the WHO 2017 testing guidelines. RESULTS: The innovation contest received 64 entries from 27 countries and took a total of 4 months to complete. Sixteen entries were directly included in the WHO testing guidelines. The entries covered testing in different populations, including primary care patients (n = 5), people who inject drugs (PWID) (n = 4), pregnant women (n = 4), general populations (n = 4), high-risk groups (n = 3), relatives of people living with hepatitis B and C (n = 2), migrants (n = 2), incarcerated individuals (n = 2), workers (n = 2), and emergency department patients (n = 2). A variety of different testing delivery approaches were employed, including integrated HIV-hepatitis testing (n = 12); integrated testing with harm reduction and addiction services (n = 9); use of electronic medical records to support targeted testing (n = 8); decentralization (n = 8); and task shifting (n = 7). CONCLUSION: The global innovation contest identified a range of local hepatitis testing approaches that can be used to inform the development of testing strategies in different settings and populations. Further implementation and evaluation of different testing approaches is needed.

Barriers to retention in methadone maintenance therapy among people who inject drugs in Bangkok, Thailand: a mixed-methods study.

BACKGROUND: Methadone maintenance therapy (MMT) is a mainstay for treating opioid use disorder and preventing and managing HIV among people who inject drugs (PWID). While previous research suggested low dosing of methadone and high rates of discontinuation of MMT among PWID in Thailand, little is known about patients' lived experiences with MMT in this setting. Therefore, we conducted a mixed-methods study to examine barriers to retention in MMT among PWID in Bangkok, Thailand, with particular attention to methadone dosing. METHODS: Bivariate statistics were used to analyze quantitative survey data collected from methadone-treated PWID between July and October 2011. Qualitative data collected through semi-structured interviews with 16 methadone-treated PWID between July 2011 and June 2012 were analyzed thematically, with a focus on individual-level, social-structural, and environmental barriers to accessing MMT. RESULTS: Among 158 survey participants, a median dosage of methadone was 30 mg/day (interquartile range 20-50). Of these, 15.8% reported having acquired street methadone due to low prescribed dosages of methadone and 19.0% reported recent syringe sharing. Qualitative interview data indicated some methadone provider-related barriers, including discouraging patients from using methadone due to it being a Western medicine, difficulty negotiating higher doses of methadone, and abrupt dose reductions without patient consultation (involving the provision of non-medicated "syrup" in some cases). Social-structural and environmental barriers to optimal MMT access included intense police surveillance of methadone clinics; and frequent incarceration of PWID and a lack of access to methadone in prisons. CONCLUSIONS: Among our sample of methadone-treated PWID, methadone dosages were suboptimal according to the international guidelines. Poor adherence to international guidelines for opioid agonist therapies, aggressive law enforcement, and a lack of methadone in prisons need to be addressed to optimize MMT and reduce harms associated with untreated opioid use disorder in Thailand.

Contextual factors associated with rushed injecting among people who inject drugs in Thailand.

People who inject drugs (IDU) often rush their injections; however, the prevalence and predictors of rushing during injecting has not been well studied. We sought to identify correlates of rushed injecting among a community-recruited sample of IDU in Bangkok, Thailand. Data were derived from IDU who participated in the Mitsampan Community Research Project in Bangkok between July and October in 2011. Multivariate logistic regression was used to identify the prevalence and factors associated with frequent rushed injecting, defined as rushing injections at least 25 % of the time in the last 6 months. Among 437 participants, 27 % reported frequent rushed injecting. In multivariate analyses, factors positively and independently associated with frequent rushed injecting included: syringe sharing, injecting in public places, and having noticed increased police presence where drugs are bought or used. Many Thai IDU in this setting reported frequent rushed injecting and factors known to increase HIV risk were found to be associated with this behavior. These findings reinforce the need for public health interventions that address the broader social and physical risk environment where drug injecting takes place.

High prevalence of syringe lending among HIV-positive people who inject drugs in Bangkok, Thailand.

BACKGROUND: Syringe sharing continues to be a major driver of the HIV pandemic. In light of efforts to enhance access to sterile syringes and promote secondary prevention among HIV-positive individuals, we sought to identify the prevalence and correlates of used syringe lending among self-reported HIV-positive people who inject drugs (PWID) in Bangkok, Thailand. FINDINGS: We used bivariable statistics to examine factors associated with self-reported syringe lending among self-reported HIV-positive PWID participating in the Mitsampan Community Research Project, a serial cross-sectional study of PWID in Bangkok, between June 2009 and October 2011. In total, 127 individuals were eligible for this analysis, including 25 (19.7%) women. Twenty-one (16.5%) participants reported syringe lending in the prior 6 months. Factors significantly associated with syringe lending included daily methamphetamine injection (odds ratio (OR) = 10.2, 95% CI, 2.1-53.6), daily midazolam injection (OR = 3.1, 95% CI, 1.1-8.7), use of drugs in combination (OR = 4.5, 95% CI, 1.0-41.6), injecting with others on a frequent basis (OR = 4.25, 95% CI, 1.3-18.3), and not receiving antiretroviral therapy (OR = 2.9, 95% CI, 1.1-7.9). CONCLUSIONS: A high prevalence of syringe lending was observed among self-reported HIV-positive PWID in Bangkok, which was associated with high intensity drug use, polysubstance use, and frequently injecting with others. It is particularly concerning that individuals who lent syringes were more likely to be untreated for HIV disease given the known benefits of antiretroviral provision on the prevention of HIV transmission. These findings underscore the need to expand access to sterile syringes and HIV treatment among HIV-positive PWID in Thailand.

HIV test avoidance among people who inject drugs in Thailand.

Case identification is a key component of HIV prevention efforts; yet rates of HIV testing remain low in some settings. We explored factors associated with HIV test avoidance among people who inject drugs (IDU) in Thailand. Between July and October 2011, 350 Thai IDU participated in the study. In bivariate analyses, male gender, high intensity drug use, syringe sharing, increased police presence, and being refused healthcare services were positively associated with HIV test avoidance, while ever receiving a hepatitis C test was negatively associated. Our findings highlight the need for interventions to reduce stigma in this setting.

The effect of exposures to policing on syringe sharing among people who inject drugs in Bangkok, Thailand.

While intensive drug law enforcement is recognized as a social-structural driver of HIV epidemics among people who inject drugs (IDU), few studies have investigated the effects of direct encounters with police, particularly in Asian settings. Using multivariate log-binomial regression, we examined the relationship between syringe sharing and exposures to two types of policing practices among IDU in Bangkok, Thailand: having been beaten by police and having been tested for illicit drugs by police. Between July and October 2011, 435 IDU participated in the study, with 75 (17.2 %) participants reporting syringe sharing in the past 6 months. In multivariate analyses, exposures to the two types of policing practices had an independent effect on syringe sharing, with experiencing both practices showing the greatest effect. These findings highlight the importance of addressing the policy and social environment surrounding IDU as a means of HIV prevention.

Reports of police beating and associated harms among people who inject drugs in Bangkok, Thailand: a serial cross-sectional study.

BACKGROUND: Thailand has for years attempted to address illicit drug use through aggressive drug law enforcement. Despite accounts of widespread violence by police against people who inject drugs (IDU), the impact of police violence has not been well investigated. In the wake of an intensified police crackdown in 2011, we sought to identify the prevalence and correlates of experiencing police beating among IDU in Bangkok. METHODS: Community-recruited samples of IDU in Bangkok were surveyed between June 2009 and October 2011. Multivariate log-binomial regression was used to identify factors associated with reporting police beating. RESULTS: In total, 639 unique IDU participated in this serial cross-sectional study, with 240 (37.6%) participants reporting that they had been beaten by police. In multivariate analyses, reports of police beating were associated with male gender (Adjusted Prevalence Ratio [APR] = 4.43), younger age (APR = 1.69), reporting barriers to accessing healthcare (APR = 1.23), and a history of incarceration (APR = 2.51), compulsory drug detention (APR = 1.22) and syringe sharing (APR = 1.44), and study enrolment in 2011 (APR = 1.27) (all p < 0.05). Participants most commonly reported police beating during the interrogation process. CONCLUSIONS: A high proportion of IDU in Bangkok reported having been beaten by the police. Experiencing police beating was independently associated with various indicators of drug-related harm. These findings suggest that the over-reliance on enforcement-based approaches is contributing to police-perpetrated abuses and the perpetuation of the HIV risk behaviour among Thai IDU.

Willingness to access peer-delivered HIV testing and counseling among people who inject drugs in Bangkok, Thailand.

Peer-based models for human immunodeficiency virus (HIV) testing have been implemented to increase access to testing in various settings. However, little is known about the acceptability of peer-delivered testing and counseling among people who inject drugs (IDU). During July and October 2011, data derived from the Mitsampan Community Research Project were used to construct three multivariate logistic regression models identifying factors associated with willingness to receive peer-delivered pre-test counseling, rapid HIV testing, and post-test counseling. Among a total of 348 IDU, 44, 38, and 36 % were willing to receive peer-delivered pre-test counseling, rapid HIV testing, and post-test counseling, respectively. In multivariate analyses, factors associated with willingness to access peer-delivered pre-test counseling included: male gender (adjusted odds ratio (AOR) = 0.48), higher than secondary education (AOR = 1.91), and binge drug use (AOR = 2.29) (all p < 0.05). Factors associated with willingness to access peer-delivered rapid HIV testing included: higher than secondary education (AOR = 2.06), binge drug use (AOR = 2.23), incarceration (AOR = 2.68), avoiding HIV testing (AOR = 0.24), and having been to the Mitsampan Harm Reduction Center (AOR = 1.63) (all p < 0.05). Lastly, binge drug use (AOR = 2.40), incarceration (AOR = 1.94), and avoiding HIV testing (AOR = 0.23) (all p < 0.05) were significantly associated with willingness to access peer-delivered post-test counseling. We found that a substantial proportion of Thai IDU were willing to receive peer-delivered HIV testing and counseling. These findings highlight the potential of peer-delivered testing to complement existing HIV testing programs that serve IDU.

Drug-related harm among people who inject drugs in Thailand: summary findings from the Mitsampan Community Research Project.

BACKGROUND: For decades, Thailand has experienced high rates of illicit drug use and related harms. In response, the Thai government has relied on drug law enforcement to address this problem. Despite these efforts, high rates of drug use persist, and Thailand has been contending with an enduring epidemic of human immunodeficiency virus (HIV) among people who inject drugs (IDU). METHODS: In response to concerns regarding drug-related harm in Thailand and a lack of research focused on the experiences and needs of Thai IDU, the Mitsampan Community Research Project was launched in 2008. The project involved administering surveys capturing a range of behavioral and other data to community-recruited IDU in Bangkok in 2008 and 2009. RESULTS: In total, 468 IDU in Bangkok were enrolled in the project. Results revealed high rates of midazolam injection, non-fatal overdose and incarceration. Syringe sharing remained widespread among this population, driven primarily by problems with access to syringes and methamphetamine injection. As well, reports of police abuse were common and found to be associated with high-risk behavior. Problems with access to evidence-based drug treatment and HIV prevention programs were also documented. Although compulsory drug detention centers are widely used in Thailand, data suggested that these centers have little impact on drug use behaviors among IDU in Bangkok. CONCLUSIONS: The findings from this project highlight many ongoing health and social problems related to illicit drug use and drug policies in Bangkok. They also suggest that the emphasis on criminal justice approaches has resulted in human rights violations at the hands of police, and harms associated with compulsory drug detention and incarceration. Collectively, the findings indicate the urgent need for the implementation of evidence-based policies and programs in this setting.

HIV testing and willingness to get HIV testing at a peer-run drop-in centre for people who inject drugs in Bangkok, Thailand.

BACKGROUND: Regular HIV testing among people who inject drugs is an essential component of HIV prevention and treatment efforts. We explored HIV testing behaviour among a community-recruited sample of injection drug users (IDU) in Bangkok, Thailand. METHODS: Data collected through the Mitsampan Community Research Project were used to examine correlates of HIV testing behaviour among IDU and to explore reasons for not being tested. Multivariate logistic regression was used to examine factors associated with willingness to access HIV testing at the drug-user-run Mitsampan Harm Reduction Centre (MSHRC). RESULTS: Among the 244 IDU who participated in this study, 186 (76.2%) reported receiving HIV testing in the previous six months. Enrolment in voluntary drug treatment (odds ratio [OR] = 2.34; 95% confidence interval [CI]: 1.18-4.63) and the tenofovir trial (OR = 44.81; 95%CI: 13.44-149.45) were positively associated with having been tested, whereas MSHRC use (OR = 1.78; 95%CI: 0.96-3.29) was marginally associated with having been tested. 56.9% of those who had not been tested reported in engaging in HIV risk behaviour in the past six months. 181 (74.2%) participants were willing to be tested at the MSHRC if testing were offered there. In multivariate analyses, willingness to get HIV testing at the MSHRC was positively associated with ever having been to the MSHRC (adjusted odds ratio [AOR] = 2.42; 95%CI: 1.21-4.85) and, among females, being enrolled in voluntary drug treatment services (AOR = 9.38; 95%CI: 1.14-76.98). CONCLUSIONS: More than three-quarters of IDU received HIV testing in the previous six months. However, HIV risk behaviour was common among those who had not been tested. Additionally, 74.2% of participants were willing to receive HIV testing at the MSHRC. These findings provide evidence for ongoing HIV prevention education, as well potential benefits of incorporating HIV testing for IDU within peer-led harm reduction programs.

Collective empowerment while creating knowledge: a description of a community-based participatory research project with drug users in Bangkok, Thailand.

In light of growing concerns regarding the ongoing drug war in Thailand and a lack of support for people who inject drugs in this setting, in 2008, we undertook a community-based participatory research project involving a community of active drug users at a peer-run drop-in center in Bangkok. This case study describes a unique research partnership developed between academic and active drug users and demonstrates that participatory approaches can help empower this vulnerable population while generating valid research. Further research is needed to explore ways of optimizing community-based participatory research methods when applied to drug-using populations.

Compulsory drug detention center experiences among a community-based sample of injection drug users in Bangkok, Thailand.

BACKGROUND: Despite Thailand's official reclassification of drug users as "patients" deserving care and not "criminals," the Thai government has continued to rely heavily on punitive responses to drug use such as "boot camp"-style compulsory "treatment" centers. There is very little research on experiences with compulsory treatment centers among people who use drugs. The work reported here is a first step toward filling that gap. METHODS: We examined experiences of compulsory drug treatment among 252 Thai people who inject drugs (IDU) participating in the Mitsampan Community Research Project in Bangkok. Multivariate logistic regression was used to identify factors independently associated with a history of compulsory treatment experience. RESULTS: In total, 80 (31.7%) participants reported a history of compulsory treatment. In multivariate analyses, compulsory drug detention experience was positively associated with current spending on drugs per day (adjusted odds ratio [AOR] = 1.86; 95%CI: 1.07 - 3.22) and reporting drug planting by police (AOR = 1.81; 95%CI: 1.04 - 3.15). Among those with compulsory treatment experience, 77 (96.3%) reported injecting in the past week, and no difference in intensity of drug use was observed between those with and without a history of compulsory detention. CONCLUSION: These findings raise concerns about the current approach to compulsory drug detention in Thailand. Exposure to compulsory drug detention was associated with police abuse and high rates of relapse into drug use, although additional research is needed to determine the precise impact of exposure to this form of detention on future drug use. More broadly, compulsory "treatment" based on a penal approach is not consistent with scientific evidence on addressing drug addiction and should be phased out in favor of evidence-based interventions.

Overdose experiences among injection drug users in Bangkok, Thailand.

BACKGROUND: Although previous studies have identified high levels of drug-related harm in Thailand, little is known about illicit drug overdose experiences among Thai drug users. We sought to investigate non-fatal overdose experiences and responses to overdose among a community-recruited sample of injection drug users (IDU) in Bangkok, Thailand. METHODS: Data for these analyses came from IDU participating in the Mit Sampan Community Research Project. The primary outcome of interest was a self-reported history of non-fatal overdose. We calculated the prevalence of past overdose and estimated its relationship with individual, drug-using, social, and structural factors using multivariate logistic regression. We also assessed the prevalence of ever witnessing an overdose and patterns of response to overdose. RESULTS: These analyses included 252 individuals; their median age was 36.5 years (IQR: 29.0 - 44.0) and 66 (26.2%) were female. A history of non-fatal overdose was reported by 75 (29.8%) participants. In a multivariate model, reporting a history of overdose was independently associated with a history of incarceration (Adjusted Odds Ratio [AOR] = 3.83, 95% Confidence Interval [CI]: 1.52 - 9.65, p = 0.004) and reporting use of drugs in combination (AOR = 2.48, 95% CI: 1.16 - 5.33, p = 0.019). A majority (67.9%) reported a history of witnessing an overdose; most reported responding to the most recent overdose using first aid (79.5%). CONCLUSIONS: Experiencing and witnessing an overdose were common in this sample of Thai IDU. These findings support the need for increased provision of evidence-based responses to overdose including peer-based overdose interventions.

High rates of midazolam injection among drug users in Bangkok, Thailand.

BACKGROUND: Reports from Thailand suggest that a growing number of people who inject drugs (IDU) are now injecting midazolam, a legal benzodiazepine with potent amnestic and ventilatory depressant effects. We therefore sought to examine midazolam injection among a community-recruited sample of Thai IDU. METHODS: We examined the prevalence and correlates of midazolam injection among 252 IDU participating in the Mitsampan Community Research Project, Bangkok, using multivariate logistic regression. We also examined the use of midazolam in combination with other drugs. RESULTS: 252 IDU participated in this study, including 66 (26.2%) women. In total, 170 (67.5%) participants reported ever having injected midazolam, and 144 (57.1%) reported daily midazolam injection in the past six months. In multivariate analyses, a history of midazolam injection was independently associated with using drugs in combination (adjusted odds ratio [AOR] = 5.86; 95% confidence interval [CI]: 2.96-11.60), younger age (AOR = 0.43; 95%CI: 0.22-0.83), having a history of methadone treatment (AOR = 3.12, 95%CI: 1.55-6.90), and binge drug use (AOR = 2.25, 95%CI: 1.09-4.63). The drugs most commonly used in combination with midazolam were heroin (72.3%) and yaba (methamphetamine) (30.5%). CONCLUSION: We observed a high rate of midazolam injection among Thai IDU. Midazolam injection was strongly associated with polysubstance use and binge drug use, and was most commonly used in combination with both opiates and methamphetamines. Our findings suggest that midazolam injection has become increasingly common within Thailand. Evidence-based approaches for reducing harms associated with midazolam injection are needed.

Incarceration experiences among a community-recruited sample of injection drug users in Bangkok, Thailand.

BACKGROUND: Since 2003 Thailand has waged an aggressive "war on drugs" campaign focused on arresting and incarcerating suspected drug users and dealers. However, little is known about incarceration experiences among IDU in the wake of the recent war on drugs. Therefore, we sought to examine incarceration experiences among IDU in Bangkok, Thailand. METHODS: We examined the prevalence of incarceration among community-recruited IDU participating in the Mitsampan Community Research Project. Multivariate logistic regression was used to identify factors associated with a self-reported history of incarceration. We also examined the prevalence of injection drug use and syringe sharing within prisons. RESULTS: 252 IDU were recruited in August 2008; 66 (26.2%) were female and the median age was 36.5 years. In total, 197 (78.2%) participants reported a history of incarceration. In multivariate analyses, reporting a history of incarceration was associated with a history of compulsory drug treatment (adjusted odds ratio [AOR] = 4.93; 95% confidence interval [CI]: 1.95 - 12.48), non-fatal overdose (AOR = 3.69; 95%CI: 1.45 - 9.39), syringe sharing (AOR = 2.20; 95%CI: 1.12 - 4.32), and female gender (AOR = 0.41; 95%CI: 0.20 - 0.82). Among those who reported a history of incarceration, 59 (29.9%) reported injection drug use in prison, and 48 (81.4%) of these individuals reported sharing syringes in prison. Incarceration was not associated with the number of injections performed in the previous week (p = 0.202). CONCLUSION: Over three-quarters of the IDU participating in this study reported a history of incarceration, and 30% of these individuals reported injection drug use within prison. Further, an alarmingly high level of syringe sharing within prison was reported, and incarceration was not associated with reductions in drug use. These findings provide further evidence of the need for community diversion strategies, as well as harm reduction programs, in Thai prisons.

Reports of evidence planting by police among a community-based sample of injection drug users in Bangkok, Thailand.

BACKGROUND: Drug policy in Thailand has relied heavily on law enforcement-based approaches. Qualitative reports indicate that police in Thailand have resorted to planting drugs on suspected drug users to extort money or provide grounds for arrest. The present study sought to describe the prevalence and factors associated with this form of evidence planting by police among injection drug users (IDU) in Bangkok. METHODS: Multivariate logistic regression was used to identify factors associated with evidence planting of drugs by police among a community-based sample of IDU in Bangkok. We also examined the prevalence and average amount of money paid by IDU to police in order to avoid arrest. RESULTS: 252 IDU were recruited between July and August, 2008, among whom 66 (26.2%) were female and the median age was 36.5 years. In total, 122 (48.4%) participants reported having drugs planted on them by police. In multivariate analyses, this form of evidence planting was positively associated with midazolam use (Adjusted Odds Ratio [AOR] = 2.84; 95% Confidence Interval [CI]: 1.58 - 5.11), recent non-fatal overdose (AOR = 2.56; 95%CI: 1.40 - 4.66), syringe lending (AOR = 2.08; 95%CI: 1.19 - 3.66), and forced drug treatment (AOR = 1.88; 95%CI: 1.05 - 3.36). Among those who reported having drugs planted on them, 59 (48.3%) paid police a bribe in order to avoid arrest. CONCLUSION: A high proportion of community-recruited IDU participating in this study reported having drugs planted on them by police. Drug planting was found to be associated with numerous risk factors including syringe sharing and participation in government-run drug treatment programs. Immediate action should be taken to address this form of abuse of power reportedly used by police.

Thailand: government re-launches war on drugs and people who use drugs.

On 2 April 2008, Thailand Prime Minister Samak Sundarajev announced a new national drug strategy. Called "Thai Power, To Avoid the Danger of Drugs," the strategy is intended to run for six months (from April to September 2008) and includes a number of activities designed to reduce the number of people who use drugs in Thailand.

Thailand: report analyses barriers to ART for people who inject drugs.

The HIV epidemic among people who use drugs mars Thailand's reputation as a success story in the global fight against AIDS. A new report has revealed that people who use drugs still face serious obstacles in obtaining needed health care

Getting global funds to those most in need: the Thai Drug Users' Network.

The Thai Drug Users' Network (TDN) formed in 2002 in response to the deplorable health and human rights conditions facing illicit drug users in Thailand. In 2003, TDN submitted a proposal for funding to the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM). The proposal appeared destined to fail as it did not have the support of the Thai government and because the interventions proposed were highly incongruent with national policies. In the midst of an ongoing drug war, TDN took action to increase awareness of the harms of the drug war, the shortcomings in GFATM policies, and the need for peer-driven interventions. This article describes the circumstances surrounding this instance of successful drug-user organizing in order to identify the lessons that can be learned.

'Drug users stick together': HIV testing in peer-based drop-in centres among people who inject drugs in Thailand.

UNLABELLED: Introduction Although there is a well recognised need for novel approaches to HIV testing, particularly for marginalised populations at high risk for HIV infection, there remains a dearth of information on the acceptability of peer-based HIV testing among people who inject drugs (PWID). METHODS: Between July 2011 and June 2012, 22 in-depth interviews were conducted with PWID participating in the Mitsampan Community Research Project in Bangkok, Thailand. Semi-structured interviews explored willingness to access rapid HIV testing delivered by a healthcare professional or a trained peer within peer-based drop-in centres. Audio-recorded interviews were transcribed verbatim and a thematic analysis was conducted. RESULTS: All participants indicated interest in accessing rapid HIV testing by a healthcare professional at peer-based drop-in centres due to the advantage of receiving immediate results. Experiencing stigma and discrimination by healthcare workers and wanting to avoid administrative barriers in hospitals were also reported as reasons for why PWID preferred HIV testing in peer-based settings. Peer support and shared lived experiences were repeatedly mentioned as benefits of peer-based testing. However, some concerns regarding peer-delivered testing were expressed and included a fear of peers' violating confidentiality and concerns regarding peers' qualifications for conducting an HIV test. CONCLUSION: Many PWID in this study sample noted the value of a peer-based approach to receiving testing and indicated their willingness to access rapid HIV testing in peer-based drop-in centres. The findings from this study highlight the potential for novel peer-based methods to complement existing HIV services in an effort to improve access to testing among this population.