Table 2 Characteristics of included studies
Author/ref | Study design (recruitment, location) | N | Nature of drug use | % male | Conflict/ contextual indicator | Age (mid point) | Outcomes | Quality score |
|---|---|---|---|---|---|---|---|---|
Afghanistan | ||||||||
Cross-sectional (community/DTS, Kabul) | 464 | PWID Heroin | 100% (1 F) | 86.4% lived or worked outside the country in last 10 years (primarily due to conflict) | 60% > = 30 years | HIV, HCV, HBV | 7/10 | |
Lived outside Afghanistan in last 10 years | 5/10 | |||||||
Access to DTS | 5/10 | |||||||
Todd, 2010 [56] | Cross-sectional (community/DTS, Hirat, Kabul, Jalalabad, Mazar-i-Sharif) | 1078 | PWID Heroin | 100% | 96.8% lived or worked outside country in last 10 years (Pakistan, Iran, other) | 28 | Syphilis Ever condom use with female sex worker | 8/10 |
Todd, 2011[57] | Cross-sectional (TLS, Kabul) | 483 | PWID Heroin with Avil | 100% | 64.7% lived outside Afghanistan in last 5 years, 63.1% ever in prison | 29.6 | HIV, HCV, HBV Access to NSP | 6/10 |
Bautista, 2010[31] | Cross-sectional (community/DTS, Kabul) | 459 | PWID Heroin | 100% | N/A | 30.4 | HCV | 6/10 |
Nasir, 2011 [41] | Cross-sectional (TLS. Hirat, Jalalabad, Mazar-i-Sharif) | 623 | PWID Heroin/Avil | 100% (1 F) | 85.2% lived or worked outside of Afghanistan; 62.9% ever in prison | N/A | HIV, HCV, HBV Sharing n/s; re-injecting blood; help with injecting | 7/10 |
Abadi, 2012 [29] | Cross-sectional (DTS, n/a) | 176 | PWUD Opium, crystal, hashish, heroin (no injecting reported) | 0% (all F) | 5% forced to work in poppy cultivation; 13% lost family member to conflict in past 2 years | 39 | Mental health, human rights violations | 2/10 |
Ruisenor-Escudero, 2014 [46] | Cross-sectional (RDS, Kabul, Herat, Mazar-i-Sharif) | 548 | PWID Heroin, opium, crystal | 100% | 88% had lived outside of Afghanistan; 40.1% unable to read or write | 28 | HIV and HCV | 9/10 |
Ruisenor-Escudero, 2015 [45] | Cross-sectional (OST clinic, Kabul) | 83 | PWID Heroin | 100% | 51.8% ever been in prison | 32.3 | Retention into OST | 4/10 |
Cohort (TLS, Kabul) | 385 | PWID Heroin | 100% | 65% lived outside Afghanistan in last 5 years; 63% ever been in prison; 26% homeless; 36% initiated injecting as a refugee | 28 | HCV and HIV Prevalence and incidence | 7/9 | |
Syringe sharing; paying women for sex; STI symptoms* | 5/9 | |||||||
Rasekh, 2018 [43] | Cross-sectional (Convenience, Kabul) | 327 | PWUD Heroin, Crystal (94% smoking) | 100% | 77.4% had migrated to Kabul from other provinces | 30.1 | Drug treatment completion | 7/10 |
Rasekh, 2019 [44] | Cross-sectional (DTS Kabul) | 410 | PWUD 13.4% inject; heroin (86%; crystal methamphetamine 7.6%) | 100% | 53.4% illiterate; 42.2% started using drugs in other countries (38.8% in Iran) | 31.5 | HCV, HIV, HBV Prevalence of injecting | 6/10 |
Pakistan | ||||||||
Zafar,2003[62] | Cross-sectional (DTS, (Quetta) | 956 | PWUD 97% Heroin but 13.2% inject | 100% | 14.9% from Afghanistan, 20% homeless, 36.8% ever arrested; 69% of Afghans inject | 35 | Currently injects drugs, use of opiates as first drug; sex with sex worker | 4/10 |
Colombia | ||||||||
Berbesi-Fernandez, 2013 Saluld mental[34] | Cross-sectional (RDS, Pereira, Medellin) | 540 | PWID Heroin (100%) basuco (40.7%) cocaine (60%) | 92.8% | 76.6% low socio-economic status | 85.7% < 30 | Needle/syringe sharing | 3/10 |
Berbesi-Fernandez, 2013 JSU[33] | Cross-sectional (RDS, 3 cities n/a) | 796 | PWID Heroin (100%) Cocaine (58.4%) | 92% | 62.5% low income status | 26.6 | Needle/syringe sharing | 6/10 |
Berbesi-Fernandez, 2015 [36] | Cross-sectional (RDS, Armenia) | 250 | PWID Heroin | 87% | 20.8% street vendors, 83% low-level socio-economic status | 26.8 | HCV and HIV | 6/10 |
Berbesi-Fernandez, 2017[37] | Cross-sectional (RDS, Armenia, Cucuta, Medellin and Bogota) | 668 | PWID Heroin | 82.2% | n/a | 26 | HCV and HIV | 6/10 |
Toro-Tobon 2018[61] | Cross-sectional (RDS, Armenia, Bogotá, Cúcuta and Pereira) | 918 | PWID Mainly heroin | 86% | 75.% % low socioeconomic level | 26 | HCV | 7/10 |
Toro-Tobon 2020 | Colombia Armenia, Bogotá, Cúcuta and Pereira) | 1123 | PWID Heroin and cocaine (% n/a) | 86.3% | 8.4% engaged in illicit work 59.3% engaged in informal work | 52.1% < 25 | HCV, HIV coinfection | 7/10 |
Sharing needles/syringes | 7/10 | |||||||
Berbesi-Fernandez, 2020 [35] | Cross-sectional (RDS, Medellin) | 224 | PWID (not stated) | 86.2% | 80.6% less than minimum wage 63.4% sold drugs | HIV | 7/10 | |
Borda, 2021 [38] | Cross-sectional (DTS, Armenia, Pereira, Cali, Medellin) | 171 | PWID Heroin (87.1%) basuco (51.5%), cocaine 31%) | 84.8% | 26.7% homeless; 41.5% unemployed | 29.7 | HIV, HV prevalence, testing and treatment | 3/10 |
Myanmar | ||||||||
Morineau, 2000[40] | Cross-sectional (DTS, Myktyina) | 272 | PWUD Heroin, opium 46.7% inject | 98% | n/a | 49.3%16–25 years | Sharing injecting equipment | 2/10 |
Swe, 2010 [51] | Cross-sectional (DTS, Shan State) | 217 | PWID Heroin, opium | 97.2% | 15.7% illiterate, 51.6% rural locations | 32.8 | HIV | 7/9 |
Swe, 2012 [52] | Cross-sectional (DTS, Shan, Kachin, Mandalay, Yangon) | 590 | PWID Heroin/opium. (89% injecting) | 98% | 17.6% unemployed | 10% < 21 years | HIV | 2/10 |
Cross-sectional (RDS, Lashio) | 368 | Heroin (PWID) Stimulants (58.6%) and heroin (41.4%) (PWUD) | 100% | 12.7% PWID and 31.9% PWUD internal migrants | 29.8 PWID; 25.5 PWUD | Ever testing for HIV | 7/10 | |
210 | PWUD Stimulants (58.6%) and heroin (41.4%) | 100% | 31.9% internal migrants 16.2% non-regular employment | 25.5 | Exchange sex | 8/10 | ||
Saw, 2014 [47] | Cross-sectional (RDS, Muse) | 776 | PWUD Methamphetamine | 58.6% | 48.8% internal migrants; 41.9% unemployed | 21.2 | Ever testing for HIV | 7/10 |
Saw, 2018[48] | Cross-sectional (RDS, Muse) | 1183 | PWUD Methamphetamine | 65.2% | 61.4% internal migrants 70.8% unemployed | 24.5% under 20 | Sexual risk (inconsistent condom use; 2 or more sex partners in last 5 months, history of STI or current infection) | 7/10 |
O’Keefe, 2018[42] | Cross-sectional (convenience and snowball, Yangon, Mandalay, Pyin Oo Lwin) | 513 | PWID Heroin | 97% | 25% unemployed, 4% unstably housed | 27 | Coverage of NSP | 7/10 |
Aye, 2018[30] | Cohort (DTS, Yangon) | 642 | PWID Heroin | 97.7% | n/a | 27 | HIV, HBV, HCV Drop out of OST | 8/9 |
Lum, 2020[39] | Cohort study (DTS, Mykitkyina) | 287 | PWID Heroin | 100% (1 F) | n/a | 28 | ART initiation | 6/9 |
Myanmar/China border | ||||||||
Zhou, 2011 [63] | Cross-sectional/ Myanmar: community China: community & OST | 721 | PWID Heroin | 403 Chinese/318 Burmese) | 32.3 (Chinese) 31.8 (Burmese) | HCV, HBV, HIV | 4/10 | |