Document Type : Original Article


1 Department of Epidemiology, School of Health, Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

2 PhD of Epidemiology Community Based Participatory Research Center, Iranian Institute for Reduction of High-Risk Behaviors, Tehran, Iran

3 PhD of Biostatistics Department of Biostatistics and Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran


Background: The goal of this study was to analyze the cost-effectiveness of harm reduction programs among Intravenous Drug Users (IDUs) who referred to Drop-In Centers (DICs) for prevention of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) infection.
Methods: To calculate the cost-effectiveness of HIV/AIDS prevention, we used data from a cross-sectional study carried out in 2009 in which we selected 13 DICs out of 45 active DICs using systematic random sampling. Through interview, data of all IDUs (1309) who had attended DICs were collected by means of a questionnaire approved by 3 experts. Averted cases of HIV infection were considered as the unit of effectiveness. The cost was also calculated from the perspective of governmental service provider and all costs were converted into US dollar (USD). Sensitivity analysis was used to measure the effect of some uncertain parameters in modeling the number of HIV cases that have been averted; also, Incremental Cost-Effectiveness Ratio (ICER) was estimated.
Results: Results showed that the DICs averted around 120.2 HIV cases in one year (102.977 cases from drug injection, 11.45 cases from homosexual and 5.77 cases from heterosexual ways). ICER for each HIV infection averted was 13,248.5 USD. Sensitivity analysis showed that providing harm reduction services in the best and worst case scenarios could change the ICER from 13,055 to 13,954 USD for each HIV case averted, respectively.
Conclusion: Since the most common cause of transmission and spread of HIV infection in Iran is drug injection via needle shared by IDUs, DICs programs in.


1.            Khorvash F, Mohamadirizi S, Ataiee B, Khayamim N, Boroumandfar Z. The Relationship between Knowledge, Attitude and Tendency to Care of HIV/AIDS Patients among Nurses and Midwives, Working in General Hospitals and Health Care Centers of Isfahan University of Medical Sciences, 2013. Journal of Midwifery and Reproductive Health. 2014;2(4):246-52.
2.            Mamo T, Moseman EA, Kolishetti N, Salvador-Morales C, Shi J, Kuritzkes DR, et al. Emerging nanotechnology approaches for HIV/AIDS treatment and prevention. Nanomedicine. 2010;5(2):269-85.
3.            Al-Ghanim SA. Exploring public knowledge and attitudes towards HIV/AIDS in Saudi Arabia. A survey of primary health care users. Saudi medical journal. 2005;26(5):812-8.
4.            Heidari A, Mirahmadizadeh A, Keshtkaran A, Javanbakht M, Etemad K, Lotfi M. Changes in unprotected sexual behavior and shared syringe use among addicts referring to Methadone Maintenance Treatment (MMT) centers affiliated to Shiraz University of Medical Sciences in Shiraz, Iran: An uncontrolled interventional study. Journal of School of Public Health and Institute of Public Health Research. 2011;9(1):67-76.
5.            Nasirian M, Doroudi F, Gooya MM, Sedaghat A, Haghdoost AA. Modeling of human immunodeficiency virus modes of transmission in Iran. Journal of research in health sciences. 2012;12(2):81-7.
6.            Kim SW, Pulkki-Brannstrom A-M, Skordis-Worrall J. Comparing the cost effectiveness of harm reduction strategies: a case study of the Ukraine. Cost Effectiveness and Resource Allocation. 2014;12(1):1.
7.            Mathers BM, Degenhardt L, Phillips B, Wiessing L, Hickman M, Strathdee SA, et al. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. The Lancet. 2008;372(9651):1733-45.
8.            Mirahmadizadeh A, Majdzadeh R, Mohammad K, Forouzanfar M. Prevalence of HIV and hepatitis C virus infections and related behavioral determinants among injecting drug users of drop-in centers in Iran. Iranian Red Crescent Medical Journal. 2009;11(3):325.
9.            MOZAFAR ZS, Vahdaninia M. AIDS literacy among female high school students: a cross-sectional study from Iran. 2008.
10.          Karimi M, Niknami S. Self-efficacy and perceived benefits/barriers on the AIDs preventive behaviors. Journal of Kermanshah University of Medical Sciences (J Kermanshah Univ Med Sci). 2011;15(5).
11.          Khajehkazemi R, Osooli M, Sajadi L, Karamouzian M, Sedaghat A, Fahimfar N, et al. HIV prevalence and risk behaviours among people who inject drugs in Iran: the 2010 National Surveillance Survey. Sexually transmitted infections. 2013:sextrans-2013-051204.
12.          Ohiri K, Claeson M, Razzaghi E, Nassirimanesh B, Afshar P, Power R. HIV/AIDS prevention among injection drug users: Learning from harm reduction in Iran. 2006. Iran: HIV Prevention Consultation. 2007.
13.          Laufer FN. Cost-effectiveness of syringe exchange as an HIV prevention strategy. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2001;28(3):273-8.
14.          Wodak A, Cooney A. Effectiveness of sterile needle and syringe programmes. International Journal of Drug Policy. 2005;16:31-44.
15.          Zhang L, Chen X, Zheng J, Zhao J, Jing J, Zhang J, et al. Ability to access community-based needle-syringe programs and injecting behaviors among drug users: a cross-sectional study in Hunan Province, China. Harm reduction journal. 2013;10(1):1.
16.          Belani HK, Muennig PA. Cost-effectiveness of needle and syringe exchange for the prevention of HIV in New York City. Journal of HIV/AIDS & Social Services. 2008;7(3):229-40.
17.          Zhang L, Yap L, Xun Z, Wu Z, Wilson DP. Needle and syringe programs in Yunnan, China yield health and financial return. BMC Public Health. 2011;11(1):1.
18.          Smith M, Saunders R, Stuckhardt L, McGinnis JM. Best care at lower cost: the path to continuously learning health care in America: National Academies Press; 2013.
19.          Niëns L. Affordability in Health Care: Operationalizations and Applications in Different Contexts. 2014.
20.          French MT, Martin RF. The costs of drug abuse consequences: a summary of research findings. Journal of substance abuse treatment. 1996;13(6):453-66.
21.          Keshtkaran A, Mirahmadizadeh A, Heidari A, Javanbakht M. Cost-effectiveness of methadone maintenance treatment in prevention of hiv among drug users in Shiraz, south of Iran. Iranian Red Crescent Medical Journal. 2014;16(1).
22.          Vazirian M. Review of drug demand reduction programs in Iran: Advices for development and strategic planning. 2003.
23.          Hesam S HN, Vahdat S. Cost-effectiveness of methadone and buprenorphine to the prevention of AIDS in intravenous drug users (Case Study: Addiction treatment centers selected under the supervision of Shiraz University of Medical Sciences and Health Services). Accounting Journal of Health. 2014;3(3):18-39.
24.          Pham QD, Wilson DP, Kerr CC, Shattock AJ, Do HM, Duong AT, et al. Estimating the Cost-Effectiveness of HIV Prevention Programmes in Vietnam, 2006-2010: A Modelling Study. PloS one. 2015;10(7):e0133171.
25.          Javanbakht M, Mirahmadizadeh A, Mashayekhi A. The Long-Term Effectiveness of Methadone Maintenance Treatment in Prevention of Hepatitis C Virus Among Illicit Drug Users: A Modeling Study. Iranian Red Crescent Medical Journal. 2014;16(2).
26.          Keshtkaran A HA, Javanbakht M, Mirahmadizadeh AR. Cost-effectiveness of methadone maintenance centers to prevent HIV among intravenous drug users. Payesh 2012;11(6):823-30.
27.          Kumaranayake L, Pepperall J, Goodman H, Mills A, Walker D. Costing guidelines for HIV prevention strategies. 2000.
28.          Rehle T, Saidel T, Mills S, Magnani R. Evaluating programs for HIV/AIDS prevention and care in developing countries. Family Health International USA. 2006.
29.          Burrows D, Wodak A, WHO. Harm reduction in Iran: Issues for national scale up. Report for World Health Organization September. 2005.
30.          Hudgens MG, Longini IM, Vanichseni S, Hu DJ, Kitayaporn D, Mock PA, et al. Subtype-specific transmission probabilities for human immunodeficiency virus type 1 among injecting drug users in Bangkok, Thailand. American journal of Epidemiology. 2002;155(2):159-68.
31.          Baggaley RF, Boily M-C, White RG, Alary M. Risk of HIV-1 transmission for parenteral exposure and blood transfusion: a systematic review and meta-analysis. Aids. 2006;20(6):805-12.
32.          Kumaranayake L, Vickerman P, Walker D, Samoshkin S, Romantzov V, Emelyanova Z, et al. The cost‐effectiveness of HIV preventive measures among injecting drug users in Svetlogorsk, Belarus. Addiction. 2004;99(12):1565-76.
33.          Ni MJ, Fu LP, Chen XL, Hu XY, Wheeler K. Net financial benefits of averting HIV infections among people who inject drugs in Urumqi, Xinjiang, Peoples Republic of China (2005–2010). BMC Public Health. 2012;12(1):1.
34.          Bayoumi AM, Zaric GS. The cost-effectiveness of Vancouver's supervised injection facility. Canadian Medical Association Journal. 2008;179(11):1143-51.
35.          Gold M, Gafni A, Nelligan P, Millson P. Needle exchange programs: an economic evaluation of a local experience. Canadian Medical Association Journal. 1997;157(3):255-62.
36.          Avants SK, Margolin A, Usubiaga MH, Doebrick C. Targeting HIV-related outcomes with intravenous drug users maintained on methadone: a randomized clinical trial of a harm reduction group therapy. Journal of substance abuse treatment. 2004;26(2):67-78.