HIV testing trend and associated factors among people who inject drugs in Iran (2010-2020)

HIV testing is critical for HIV prevention and treatment among PWID and their social networks. This study aimed to examine the trend of HIV testing among PWID in Iran. We also assessed the factors associated with HIV testing in 2020.

This study used data from three consecutive nationwide bio-behavioral surveillance surveys (BBSS) of PWID conducted between 2010 and 2020. The primary outcome variable was a history of HIV testing and having received the results within the past 12 months. Cochran-Armitage trend test was used to assess the trend of HIV testing over the years. Bivariable and multivariable logistic regression models were used to investigate factors associated with HIV testing in 2020.

A total of 6887 HIV-negative PWID (2206 in 2010, 2092 in 2014, and 2589 in 2020) were included in the analysis. The uptake of HIV testing increased significantly from 25.1% (95% CI 23.9%, 27.6%) in 2010 to 30.0% (95% CI 28.0%, 32.0%) in 2014, and 39.3% (95% CI 37.4%, 41.2%) in 2020 (p < 0.001). In 2020, people with unstable employment (adjusted odds ratio [AOR] = 2.35, 95% CI 1.70, 3.25) had higher odds of HIV testing than those with stable employment. Also, the age at first drug use ≥ 18 years (AOR = 1.42, 95% CI 1.13, 1.80), and sufficient HIV knowledge (AOR = 1.71, 95% CI 1.37, 2.14) were significantly associated with higher odds of HIV testing.

Despite the increasing trend, HIV testing among PWID in Iran remains considerably low. Policies and strategies, such as HIV self-testing, expansion of harm reduction services to include HIV testing, and encouraging HIV testing among PWID, are required to increase HIV testing uptake in this population. Targeted interventions focusing on raising knowledge about the importance of HIV testing may contribute to further increased testing uptake among PWID.