Methamphetamine use and HIV risk behavior among men who inject drugs: causal inference using coarsened exact matching
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RESEARCH
Open Access
Methamphetamine use and HIV risk behavior among men who inject drugs: causal inference using coarsened exact matching Mehdi Noroozi1, Peter Higgs2, Alireza Noroozi3, Bahram Armoon4* , Bentolhoda Mousavi5, Rosa Alikhani5, Mohammad Rafi Bazrafshan6, Ali Nazeri Astaneh7, Azadeh Bayani8 and Ladan Fattah Moghaddam9
Abstract Background: Understanding the association between methamphetamine (MA) use and HIV risk behavior among people who inject drugs (PWID) will assist policy-makers and program managers to sharpen the focus of HIV prevention interventions. This study examines the relationship between MA use and HIV risk behavior among men who inject drugs (MWID) in Tehran, Iran, using coarsened exact matching (CEM). Methods: Data for these analyses were derived from a cross-sectional study conducted between June and July 2016. We assessed three outcomes of interest—all treated as binary variables, including distributive and receptive needle and syringe (NS) sharing and condomless sex during the month before interview. Our primary exposure of interest was whether study participants reported any MA use in the month prior to the interview. Firstly, we report the descriptive statistics for the pooled samples and matched sub-samples using CEM. The pooled and matched estimates of the associations and their 95% CI were estimated using a logistic regression model. Results: Overall, 500 MWID aged between 18 and 63 years (mean = 28.44, SD = 7.22) were recruited. Imbalances in the measured demographic characteristics and risk behaviors between MA users and non-users were attenuated using matching. In the matched samples, the regression models showed participants who reported MA use were 1.82 times more likely to report condomless sex (OR = 1.82 95% CI 1.51, 4.10; P = 0.031), and 1.35 times more likely to report distributive NS sharing in the past 30 days, as compared to MA non-users (OR = 1.35 95% CI 1.15–1.81). Finally, there was a statistically significant relationship between MA use and receptive NS sharing in the past month. People who use MA in the last month had higher odds of receptive NS sharing when compared to MA non-users (OR = 4.2 95% CI 2.7, 7.5; P = 0.013). Conclusions: Our results show a significant relationship between MA use and HIV risk behavior among MWID in Tehran, Iran. MA use was related with increased NS sharing, which is associated with higher risk for HIV exposure and transmission. Keywords: Methamphetamine, HIV, Risk Behavior, Coarsened Exact Matching, MWID
* Correspondence: [email protected] 4 Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran Full list of author information is available at the end of the article
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Cre
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