Economic Burden of HIV/AIDS in Iran: A Modelling Approach.

Background: HIV/AIDS is a leading cause of mortality and morbidity in Low-and-Middle-Income-Countries (LMICs). It might potentially lead to an economic burden on the health system. There is no certainty about the prevalence of HIV/AIDS in Iran. Therefore, we aimed to estimate the cost of illness of HIV/AIDS in Iran. Methods: We applied a societal perspective to capture the direct and indirect costs attributed to HIV/AIDS in Iran. We used data for age-standardized prevalence produced by the country HIV/AIDS Surveillance System for 2018. The study estimated both direct and indirect costs for a hypothetical cohort of the Iranian adult population (here equates to all registered cases with Surveillance System). For mitigating the uncertainty around the estimations, we have used an optimistic and pessimistic analysis. Results: The base case scenario showed that total direct costs and indirect costs attributed to the HIV/AIDS were US$7,946,530 and US$ 1,288,586 at the end of 2018. Moreover, the total cost is 8,785,116 US$. Conclusion: Direct costs have formed approximately 85% of total costs. The policymakers and planners should consider that these costs are only related to diagnosed or registered infected populations. These costs will be raised dramatically with increasing the diagnosed patients.

Transcatheter aortic valve implantation against conventional aortic valve replacement surgery in high-risk patients with aortic stenosis; a cost-effectiveness analysis.

BACKGROUND: Aortic stenosis is a prevalent heart valvular disorder in Iran. Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR) are two common procedures for treating the disease in the current clinical pathway. However, TAVI is an expensive procedure, and for Iran with severe limitations in financial resources, it is crucial to investigate the cost-effectiveness of the technology against other competing alternatives with the same purpose. This study aims to analyse the cost-effectiveness of TAVI vs SAVR in elderly patients who are at a higher risk of surgery. METHODS: This study is a decision economic evaluation modeling, with a lifetime horizon and a healthcare payer (health insurer) perspective. The utility values are from a previous study, transitional probabilities come from an established clinical trial called PARTNER-1, and the unit costs are from Iran's national fee schedule for medical services. The probabilistic and one-way sensitivity analyses have been performed to mitigate the uncertainty. RESULTS: The incremental cost, effectiveness, and cost-effectiveness ratio for the base case were: 368,180,101 Iranian Rial, (US$ 1,473), 0.37 QALY-per-patient, and, 995,081,354 Iranian Rial (US$ 3,980), respectively. The probabilistic sensitivity analysis yielded 981,765,302 I.R.I Rials (US$ 3,927) per patient for the ICER. The probability of being cost-effective at one and three times the country's Gross Domestic Production (GDP) is 0.31 and 0.83, respectively. CONCLUSIONS: TAVI does not seem a cost-effective procedure in comparison with SAVR at the current willingness to pay thresholds of the country. However, by increasing the WTP threshold to 3 times the GDP per capita the probability of being cost-effective will raise to 83%.

A Systematic Review on the Economic Evaluations Evidence of Enhanced External Counter-Pulsation (EECP) for Managing Chronic Stable Angina.

Background: Chronic Stable Angina (CSA) does not respond to clinical interventions always. Therefore, enhanced external counter pulsation (EECP) has been approved by the Food and Administration Drug (FDA) as an effective technology. This study aimed to synthesize evidence on the economic evaluation of EECP in managing CSA through a systematic approach. Methods: In this systematic review study, PubMed/Medline, Cochrane Library, Web of Sciences, Scopus, National Institute for Health Research Journals Library, and the University of York Centre for Review and Dissemination (CRD) were searched. The targeted population was people who suffered from CSA, and the main therapeutic intervention was EECP. The comparators were not limited to any particular ones. Outcomes were changes in the Canadian Cardiovascular Society grading of angina pectoris, quality of life, and any other investigated relevant outcomes in the retrieved studies. The quality of studies was assessed through Philips et al and Joanna Briggs Institute Critical Appraisal tools. We synthesized data through a narrative approach. Results: We retrieved 7821 studies; among which 3 studies were included in the final phase. Two studies were systematic reviews and the Markov model economic evaluation. Another study was a partial economic evaluation. Conclusion: All studies only considered direct costs. EECP is a cost-effective technology in managing CSA, however, the sensitivity analysis of the studies showed the cost-effectiveness ratio is varied considerably and further studies are needed to extrapolate its economic value.

Evaluating the effectiveness of abbreviated breast MRI (abMRI) interpretation training for mammogram readers: a multi-centre study assessing diagnostic performance, using an enriched dataset.

BACKGROUND: Abbreviated breast MRI (abMRI) is being introduced in breast screening trials and clinical practice, particularly for women with dense breasts. Upscaling abMRI provision requires the workforce of mammogram readers to learn to effectively interpret abMRI. The purpose of this study was to examine the diagnostic accuracy of mammogram readers to interpret abMRI after a single day of standardised small-group training and to compare diagnostic performance of mammogram readers experienced in full-protocol breast MRI (fpMRI) interpretation (Group 1) with that of those without fpMRI interpretation experience (Group 2). METHODS: Mammogram readers were recruited from six NHS Breast Screening Programme sites. Small-group hands-on workstation training was provided, with subsequent prospective, independent, blinded interpretation of an enriched dataset with known outcome. A simplified form of abMRI (first post-contrast subtracted images (FAST MRI), displayed as maximum-intensity projection (MIP) and subtracted slice stack) was used. Per-breast and per-lesion diagnostic accuracy analysis was undertaken, with comparison across groups, and double-reading simulation of a consecutive screening subset. RESULTS: 37 readers (Group 1: 17, Group 2: 20) completed the reading task of 125 scans (250 breasts) (total = 9250 reads). Overall sensitivity was 86% (95% confidence interval (CI) 84-87%; 1776/2072) and specificity 86% (95%CI 85-86%; 6140/7178). Group 1 showed significantly higher sensitivity (843/952; 89%; 95%CI 86-91%) and higher specificity (2957/3298; 90%; 95%CI 89-91%) than Group 2 (sensitivity = 83%; 95%CI 81-85% (933/1120) p < 0.0001; specificity = 82%; 95%CI 81-83% (3183/3880) p < 0.0001). Inter-reader agreement was higher for Group 1 (kappa = 0.73; 95%CI 0.68-0.79) than for Group 2 (kappa = 0.51; 95%CI 0.45-0.56). Specificity improved for Group 2, from the first 55 cases (81%) to the remaining 70 (83%) (p = 0.02) but not for Group 1 (90-89% p = 0.44), whereas sensitivity remained consistent for both Group 1 (88-89%) and Group 2 (83-84%). CONCLUSIONS: Single-day abMRI interpretation training for mammogram readers achieved an overall diagnostic performance within benchmarks published for fpMRI but was insufficient for diagnostic accuracy of mammogram readers new to breast MRI to match that of experienced fpMRI readers. Novice MRI reader performance improved during the reading task, suggesting that additional training could further narrow this performance gap.

Health equity in Iran: A systematic review.

Background: Health inequities are among debatable and challenging aspects of health systems. Achieving equity through social determinants of health approach has been mentioned in most upstream national plans and acts in Iran. This paper reports the findings of a systematic review of the current synthesized evidence on health equity in Iran. Methods: This is a narrative systematic review. The relevant concepts and terminology in health equity was found through MeSH. We retrieved the relevant studies from PubMed/MedLine, Social Sciences Database, and Google Scholar in English, plus the Jihad University Database (SID), and Google Scholar in Farsi databases from 1979 until the end of January 2018. The retrieved evidence has been assessed primarily based on PICOS criteria and then Ottawa-Newcastle Scale, and CASP for qualitative studies. We used PRISMA flow diagram and a narrative approach for synthesizing the evidence. Results: We retrieved 172 455 studies. Following the primary and quality appraisal process, 114 studies were entered in the final phase of the analysis. The main part (approximately 95%) of the final phase included cross-sectional studies that had been analyzed through current descriptive inequality analysis indicators, analytical regression, or decomposition-based approaches. The studies were categorized within 3 main groups: health outcomes (40.3%), health utilization (32%), and health expenditures (27%). Conclusion: As a part of understanding the current situation of health equity in the policymakers' need to refer the retrieved evidence in this study, they need more inputs specially regarding the social determinants of health approach. It seems that health equity research plan in Iran needs to be redirected in new paths that give appropriate weights to biological, gene-based, environmental and contextbased, economic, social, and political aspects of health as well. We advocate addressing the aspects of Social Determinant of Health (SDH) in analyzing health inequalities.

Does zinc with and without iron co-supplementation have effect on motor and mental development of children? A systematic review and meta-analysis.

BACKGROUND: Effects of zinc with and without iron co-supplementation on child development are uncertain therefore the aims of this systematic review were to explore whether supplementation with zinc alone and zinc with iron in children aged 0-5 years old have beneficial or adverse effects on their mental and motor development. METHOD: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, Web of Science and Scopus until July 2020 and included randomized controlled trials, which assessed effects of zinc supplementation with and without iron in children less than 5 years old on mental and motor development. Data were pooled by random effects model and the Standardized Mean Differences (SMDs) with 95% confidence interval were estimated. The heterogeneity was assessed by I2. RESULTS: Twenty-five studies with 11,559 participants were eligible to be included in this systematic review. Meta-analysis was conducted with eight articles that used Bayley Scales of Infant and Toddler Development II. We concluded that zinc alone and zinc with iron co-supplementation do not have beneficial or adverse effect on child mental and motor development at 6 and 12 months of age with low to moderate quality of the evidence. Furthermore, Zinc supplementation does not have any long term effect on child development in preschool and school age children. CONCLUSION: Most included studies did not show the efficacy of zinc with and without iron co-supplementation on child mental and motor development up to 9 years old age. Further Randomized Controlled Trials (RCTs) need to be taken into considerations the context-based differences between countries with special focus on socio-economic differences.

Development and validation of an inventory to measure stressful events: Findings from a population-based survey.

Background: Development of tools for measuring stress has been considered by mental health researchers for many years. The purpose of this study was to develop and validate a "Stressful Events Inventory"(SEI) using exploratory and confirmatory factor analyses. Methods: Using a representative sample (n=6000) from all people who reside in Tehran, the validity of the inventory was confirmed by exploratory and confirmatory factor analyses, and its reliability was also confirmed by Cronbach's alpha. Results: Eleven major sets of stressful events were identified as follow: political problems (α=0.731), neighborhood's problems (α=0.739), livelihood problems (α=0.609), fear of the future (α=0.663), educational events (α=0.635), educational changes (α=0.704), individual changes (α=0.463), occupational difficulties (α=0.64), housing problems (α=0.69), problems related to occupational relations (α=0.46), and family problems (α=0.69). The value of correlation between the factors was equal to 0.82 and the value of variance determined by these factors was 0.49 (r^2=0.49). In the confirmatory factor analysis, these factors also had an appropriate fitness (RMSEA=0.02). Conclusion: The developed instrument has suitable psychometric properties, which make it appropriate for future research on psychosocial stress.

Factors associated with injecting-related risk behaviors among people who inject drugs: a systematic review and meta-analysis study.

We conducted this systematic review and meta-analysis study to better understand the factors (being drug use, drug type (methamphetamine vs others), sex partner, frequency of injection, homelessness and being HIV positive) associated with injecting-related risk behaviors (lending and/or borrowing already used syringes) among people who inject drugs (PWID). We searched the English language citations in PubMed, Science Direct, Web of Science, and Cochrane electronic databases for previous studies on risk behaviors among PWID. Two independent researchers reviewed all search results, screened for eligibility and extracted data independently. A meta-analysis was conducted with pooled odds ratio and the 95% confidence intervals for factors associated with injecting risk behaviors among PWID. After detailed assessment of the citations, we included 14 studies in our meta-analysis. Binge drug use (OR, 1.39; 95% CI, 1.06-1.71) and drug type (methamphetamine vs. others) (OR, 1.50; 95% CI, 1.22-1.77) were positively associated with the borrowing of already used syringes among PWID. We also found that drug type (OR, 1.39; 95% CI, 1.16-1.64) and homelessness (OR, 1.89; 95% CI, 1.27-2.51) had a positive association with the lending of already used syringes among PWID. Additionally, being HIV positive was negatively associated with the lending of used syringes among PWID (OR, 0.58; 95% CI, 0.37-0.63). This systematic review and meta-analysis supports harm-reduction initiatives especially the establishment and maintenance of sterile needle syringe programs.

Factors associated with HIV testing among people who inject drugs: a meta-analysis.

HIV testing is the first step to early identification, treatment and management of HIV infection among people involved in high-risk behaviors specifically drug injection. Achieving declines in morbidity and mortality associated with HIV and reducing onward HIV transmission are key to testing and treatment. Evaluating the frequency of HIV testing among people who inject drugs (PWID) provides information that helps to identify missed opportunities to improve the efficacy of testing. This meta-analysis aimed to determine the association between HIV testing and risk taking behaviors among PWID. Two independent researchers reviewed the databases of PubMed, Scopus, Web of Science, and Cochrane electronic databases, for manuscripts published between 2000 and 2017, to identify primary studies on the factors associated with HIV testing among PWID. After reviewing for duplication, the full texts of 16 articles were assessed for eligibility. We used fixed and random-effects meta-analysis models to estimate the pooled prevalence, pooled odds ratio (OR) and 95% confidence intervals (CIs) from the data collected. From the four databases 15,965 studies were identified. After evaluations of the citations, article title and abstracts 16 studies were included in the analysis. Findings indicate a significant association between HIV testing and having ≥6 years education (OR = 1.19, 95% CI = 1.01-1.38), a history of imprisonment (OR = 1.92, 95% CI = 1.30-2.53), access to needle syringe programs (OR = 1.6, 95% CI = 1.00-2.21), and PWID attending a health professional or physician (OR = 1.46, 95% CI = 1.17-1.74). Appropriate strategies to increase awareness of primary care physicians on the importance of regular HIV testing will help with global targets for HIV elimination among PWID.

Determinants of road traffic injuries in Iranian children; results from a National Representative Demographic- Health Survey 2010.

BACKGROUND: Road Traffic Injuries (RTIs) are a leading cause of disabilities and mortalities in Iran. The occurrence of RTIs among children is increasing. This study aims are to assess RTIs among Iranian children and to determine the main socio-economics determinants. METHODS: The National Institute of Health Research (NIHR) in collaboration with the Iran Ministry of Health (MoH) conducted a nationwide survey: The Multiple Indicator Demographic and Health Survey 2010 (IrMIDHS 2010). The Survey was undertaken by Medical Universities in Iran. Based on multistage clustered randomized sampling, 30,960 households were included in the survey. We performed a multivariate logistic regression to determine the main socio-economic factors associated with RTIs among children. RESULTS: Approximately 0.9% of the children received RTIs in 2010. Main socio-economics contributors to RTIs involving Iranian children included household size (Adjusted OR: 1.06 (CI 95% 1.01, 1.14), sex (Adjusted ORfemale: 0.38 (CI 95% 0.29, 0.50), living with both parents (Adjusted OR: 0.55 (CI 95% 0.13, 0.95), being in the 2nd (Adjusted OR: 0.81 (CI 95%: 0.60, 0.90) or 4th income quartile (Adjusted OR: 0.13 (CI 95%: 0.02, 0.92) rather than the 1st income quartile, being aged five to nine (Adjusted OR: 1.39 (CI 95%: 1.10, 2.10), or aged 15 to 18 (Adjusted OR: 2.94 (CI 95%: 2.07, 4.97), and residency in a non- owned or non-tenancy house (Adjusted OR: 0.42 (CI 95%: 0.23 0.74). CONCLUSIONS: Children need safe places for playing and doing their daily activities. Policy and regulation development aimed at protecting children from road traffic injuries needs to take into consideration the socio-economic factors associated with risk of road traffic injury among children.

Current cigarette smoking among Iranian elders; what are the prevalence, inequality and socioeconomic determinants? An analysis on Iranian Rural and Urban Income-Expenditure Survey 2017.

This study aims to investigate the current prevalence of smoking, socioeconomic inequality, and main determinants of it among Iranian ≥60 years in 2017. The data of Iranian Rural and Urban Income-Expenditure Survey for 2017 have been obtained from Statistical Center of Iran. The prevalence rate of current smoking, inequality of current smoking through calculating the Concentration Index, and the main socioeconomic determinants of it have been investigated. The current prevalence of tobacco use in the elderly in Iran was about 11%; of which, 9% belonged to men and 2% to women. The most prevalent current tobacco uses in the elderly belonged to the age group of 70-79 years. This rate was lower in the two other borderline groups (under 70 and over 80 years of age). Furthermore, its prevalence was higher in the unemployed and married elderly, compared to their counterparts within each subgroup. Current cigarette smoking is among health problems, especially among the elderly, and its prevalence is significant in Iran.

Effects of Developmental Care on Neurodevelopment of Preterm Infants.

OBJECTIVES: The aim of this study protocol is to systematically review the literature to examine the effects of developmental care on preterm infants' neurodevelopment in the neonatal intensive care unit (NICU). MATERIALS & METHODS: Studies will be retrieved through searching the following databases: Web of Science, PubMed, EMBASE (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (EBSCO), and Scopus. Randomized controlled trials will be included with randomization at either individual or cluster level. The primary outcome will be to evaluate the effect of developmental care on the mental and motor development of NICU neonates. The secondary outcome will be neonatal weight gain and length of stay during NICU hospitalization. The assessment tool for the development should be the Bayley Scales of Infant and Toddler Development, in any of the first, second and third editions. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) will be employed to identify relevant articles and report the screening process. The agreement between two experts in developmental neonatology will be reached in selecting all studies. Afterward, data will be extracted and compared by two reviewers. Any discrepancies in the extracted data will be discussed to reach a consensus. The extracted data will be imported to Review Manager 5.3 by one reviewer. Finally, the risk of bias for all selected studies will be independently evaluated by two reviewers using the Cochrane Collaboration's tool. A meta-analysis will be performed to assess the possible quantitative impact of developmental interventions on the desired primary and secondary objectives. A random effect will be used if the I-square statistics is equal or more than 75%; otherwise, a fixed effect will be applied. Publication bias will be assessed using Egger's test and illustration with the funnel plot. The Standardized Mean Difference (SMD) with 95% confidence interval will be estimated through Metan command in STATA 14. The method provided in the Cochrane handbook will be used in this statistical analysis. The significance level will be 0.05.

Do NICU developmental care improve cognitive and motor outcomes for preterm infants? A systematic review and meta-analysis.

BACKGROUND: The aim of this study was to review the effects of developmental care in neonatal intensive care unit (NICU) setting on mental and motor development of preterm infants. METHOD: We searched PubMed, EMBASE, CINAHL, Scopus, Web of Science and Cochrane library until October 8th 2017, and included randomized controlled trials that assessed effects of developmental care in NICU on mental and motor development of preterm infants at 12 and 24 months of age, using the Bayley scale of infant development in this systematic review. In addition, data were pooled by random effects model and Standardized Mean Difference (SMD) with 95% confidence intervals (CI), calculated for meta-analysis. RESULTS: Twenty one studies were eligible to be included in this systematic review; however, only thirteen studies had data suitable for meta-analysis. According to statistical analysis, developmental care in NICU improved mental developmental index (MDI) (standardized mean difference [SMD] 0.55, 95% confidence interval [CI] 0.23-0.87; p < 0.05), and psychomotor developmental index (PDI) (SMD 0.33, [CI] 95% CI 0.08-0.57; p < 0.05) of BSID at 12 months of age and PDI at 24 months of age (SMD 0.15, 95% CI -0.02-0.32; p < 0.1) of preterm infants. However, the benefit was not detected at 24 months of age on MDI (SMD 0.15, 95% CI -0.05-0.35; p = 0.15). CONCLUSION: Current evidence suggests that developmental care in only NICU setting could have significant effect on mental and motor development of preterm infants, especially at 12 months of age. However, because of clinical heterogeneity, more studies are needed to evaluate the effects of developmental NICU care in the development of preterm infants.

Social and demographical determinants of quality of life in people who live with HIV/AIDS infection: evidence from a meta-analysis.

The aim of this meta-analysis is to summarize the available evidence on the social and demographic determinants of health-related quality of life (QoL) for HIV-infected populations in order to provide a direction to policy makers, planners, and program developers on how best to use their resources to improve the QoL of HIV-infected people.PubMed, Science Direct, Web of Science, and Cochrane electronic databases were searched (up to February 2017) to identify the relevant studies. A meta-analysis was conducted with procreate polled odds ratios (ORs and ß) and the confidence intervals of 95% on determining factors of QoL in social and demographic terms. Random effect model was applied to calculate pooled estimation, due to varied sampling methods of researches.In total, 5607 papers were identified from 4 databases and additional search in reference lists. Of these, 2107 articles were selected for full-text review. We included 19 studies that met the eligibility criteria. The pooled effect size shows a relative positive impact of social support for QoL among HIV/AIDS patients and its lower boundary is about 0.61 and the higher about 1.49. The pooled effect size has a considerable negative impact stigma on people who live with HIV/AIDS (PWLHs') QoL ranges from -0.34 to -0.32. Low socioeconomic status (poverty situation) was found to have a degenerative impact with PWLHs' QoL. Our finding indicates an association between younger 35 and QoL is negative with a relatively wide range, the minimum level of education has a weak association with PWLHs' QoL (ES: 0.14-0.2).There are several sociodemographic determinants of QoL among PWLHs and in this study, we found that stigma, low level of socioeconomic status, and being younger than 35 years old have a negative association with QoL, while the social support showed a positive association and a minimum level of education did not show a rigorous negative or positive association.

Clinical determinants associated with quality of life for people who live with HIV/AIDS: a Meta-analysis.

BACKGROUND: During recent years, Quality of Life (QoL) is a significant assessment factor in clinical trials and epidemiological researches due to the advent of Antiretroviral Therapy (ART), Human Immunodeficiency Virus (HIV) has become a manageable,chronic disease. With regards, more attention must be paid to the QoL of infected patients. Limited evidence exists on the impact of ART on QoL among HIV infected patients. Due to lacking of a systematic approach to summarizing the available evidence on the clinical determinants of People Who Live with HIV/AIDS (PWLHs') QoL, this study aimed to analyze the impact of clinical determinants (ART experience, CD4 count < 200, co-morbidities, time diagnosis and accessibility to cares) on QoL among PWLHs'. METHODS: This study was designed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, Science Direct, Web of Science, and Cochrane electronic databases were searched in February 2017 to identify all past studies that discussed social and behavioral characteristics of QoL in PLWHA. To recognize effective factors on social and behavioral QoL, a meta-analysis was conducted. Polled Odds Ratios (ORs) were utilized at a 95% confidence level. Since sampling methods differed between articles in the systematic review, we evaluated pooled estimates using a random effect model. Metan, metareg, metacum, and metabias commands in STATA version 13.0 were applied to analyze the data. RESULTS: Our findings indicated that ART has a positive impact on QoL, with a pooled effect size at approximately 1.04 with a confidence interval between 0.42 to 1.66 which indicates this impact is not very considerable and may be relatively neutral. The pooled effect size for CD4 count on QoL was .29 (95%CI = .22-.35), indicating that there is a negative associate between CD4 count and QoL. The co-morbidity as a negative determinant for QoL among HIV/AIDS infected people. The pooled effect size implies on a relative neutral association, although the confidence interval is wide and ranges between 0.32 to 1.58. The pooled effect size is about 1.82 with confidence interval 1.27 to 2.37 which indicates a considerable positive association with lowest level of heterogeneity. CONCLUSIONS: The results illustrated that time diagnosing and availability to hospital services had significant relationship with a higher QoL and CD4 < 200 was associated with a lower QoL. In conclusion, policy makers should set an agenda setting to provide a suitable diagnostic and therapeutic facilities to early detecting and continues monitoring the health status of People Who Live with HIV/AIDS (PWLHs').

Factors associated with time between using a drug and injection initiation among people who inject drugs in Kermanshah, Iran.

Background The transition from non-injection to injection drug use dramatically increases the risk of transmitting HIV and other blood borne infections including hepatitis B virus (HBV) and hepatitis C virus (HCV). The aim of this study was to explore factors associated with the transition from first illicit drug use to first injection among drug users. Methods Using snowball sampling and convenience sampling through needle and syringe programmes (NSPs), we recruited 500 people who inject drugs (PWID) in Kermanshah, between September and December 2014. Trained interviewers collected data on socio-demographic characteristics, HIV testing and drug-related risk behaviors over the last month prior to interview using a structured questionnaire. Our main outcome variable was first illicit drug use to first injection (TIJ). TIJ was calculated by subtracting age at first drug injection from age of first illicit drug use. Results Overall, the average age at first drug use and injection were 21.4 [standard deviation (SD 5.6)] and 22.8 (SD 8.9), respectively. The average duration of injection was 6.0 (SD 4.6) years. Overall, the mean of TIJ for participants was 1.4 (IQR = 2, 4) years. Age of first injecting drug use negatively correlated with TIJ (R2 = 0.219, p = 0.001). Education level and socioeconomic status (SES), and negatively correlated with TIJ. Conclusion Some demographic factors and drug use characteristics including educational level, SES, knowledge of HIV status, age of initiating drug use, being a poly drug user and using methamphetamine were predictors of the time to transition.

Decomposing inequality in financial protection situation in Iran after implementing the health reform plan: What does the evidence show based on national survey of households' budget?

BACKGROUND: Lack of well-designed healthcare financing mechanisms and high level of out-of-pocket payments in Iran over the last decades led to implementing Health Transformation Plan, in 2014. This study aims to decompose inequality in financial protection of Iranian households after the implementation of the Health Transformation Plan. METHODS: The data of Statistical Center of Iran (SCI) Survey on Rural and Urban Households Income-Expenditure in 2015 to 2016 were used. The headcount ratio of catastrophic health expenditures was calculated. The corrected concentration index was estimated. The role of contributors on inequality in the exposure to catastrophic health expenditures among poor and nonpoor households was calculated using Farelie's model. RESULTS: The headcount ratio of the exposure to catastrophic health expenditures in urban and rural households was 2.5% (2.43% - 2.64%) and 3.6% (3.48% - 3.76%), respectively. The difference in households' income levels was the main contributor in explaining the inequality in facing catastrophic health expenditures between poor and nonpoor households. [Correction added on 02 June 2018, after first online publication: The "Results" section of the Abstract of the published article has been correctly updated on this version.] CONCLUSION: Even after implementing the HTP, the headcount ratios of catastrophic health expenditure are still considerable. The results show that income is the greatest determinant of inequality in facing catastrophic health expenditure and in urban households.

Has the Financial Protection Been Materialized in Iranian Health System? Analyzing Household Income and Expenditure Survey 2003-2014.

BACKGROUND: The financial protection against catastrophic and impoverishing health expenditures is one of the main aspects of the universal health coverage. This study aimed to present a clear picture of the financial protection situation in Iran from 2003-2014. STUDY DESIGN: This is an analytical study on secondary data of Statistical Center of Iran (SCI). The study has some policy implications for policy makers; therefore, it is an applied one. METHODS: Data related to the Iranian rural and urban household payments on health expenditures was obtained from annual surveys of the SCI. WHO researchers' approach was used to calculate the Fairness of Financial Contribution Indicator (FFCI), the headcount and overshoot ratios of catastrophic and impoverishing health expenditures. A logistic regression was conducted to identify the determinants of probability of occurrence of catastrophic health expenditure among Iranian households in 2014. RESULTS: The mean of FFCI for rural and urban households was 0.854 (0.41) and 0.867 (0.32), respectively. The average headcount ratios of catastrophic and impoverishing health expenditures were 1.32% (0.24) and 0.33% (P=0.006) for rural households and 1.4% (0.6) and 0.28% (P=0.001) for urban households. Concerning rural households, the overshoot of catastrophic and impoverishing health expenditures was 14.94% (P=0.001) and 7.22% (0.53); it was 15.59% (1.54) and 7.76% (0.52) for urban households. CONCLUSIONS: No significant and considerable change was found in the headcount ratios of catastrophic and impoverishing health expenditure and in their overshoot or gap amounts. This suggested a lack of well-designed and effective schemes for materializing the financial protection in Iran.

Comparing injecting and sexual risk behaviors of long-term injectors with new injectors: A meta-analysis.

The present meta-analysis aimed to investigate the effect of injection duration on injection and sexual high-risk behaviors among people who inject drugs (PWID), in order to inform development of intensive HIV prevention services for selected PWID sub-populations. We searched PubMed, Science Direct, Web of Science, and Cochrane electronic databases independently in December 2018. After reviewing for duplication, full-texts of selected articles were assessed for eligibility using certain Population, Intervention, Comparator, Outcomes (PICO) criteria. We used fixed and random-effects meta-analysis models to estimate the pooled prevalence, pooled odds ratio (OR) and 95% confidence intervals (CI). Our result indicated significant association between age of injection initiation > 17 years, frequency of drug injection > 5 times/day, injection by others, having sex partner, history of imprisonment with new injectors (OR = 0.93, 95%CI = 0.87-0.98), (OR = 0.51, 95%CI = 0.29-0.73), (OR = 1.11, 95%CI = 1.05-1.17), (OR = 2.08, 95%CI = 1.02-3.14) and (OR = 1.20, 95%CI = 1.03-1.37). Our research found that new injectors were more likely to report frequency of injections injected by others, has sex partner and prison detention. Our findings are significant for policy makers and public health practitioners to implement and design HIV prevention programs among PWID with shorter periods of injection. The findings of the present study extend our knowledge about new injection drug users, the significance of assured behaviors at IDUs' initial injection, and the educational importance of syringe exchange programs.