Hot Spot Mapping and Size Estimation of Illicit Drug Users in Iran: A Pilot Study

Abstract Background: Mapping and size estimation of people who use (PWUD) or inject drugs (PWID) are important issues for control of drug use. The aim of this pilot study is to mapping and estimate the number of PWUD and PWID in Iran.Methods: We used the hotspot mapping and size estimation method to estimate the number of illicit drug users in four cities of Iran from December 2017 to January 2019. We identified hotspots by local knowledge of key informants. For size estimation in each hotspot, three estimates were made during hotspot visit: a) KAP-KI (Key Affected Population Key Informant) estimate (drug users met in the hotspot), b) Non-KAP KI estimate (e.g. taxi drivers, shopkeepers nearby the hotspot); c) estimation made by field observers. Locations of hotspots were recorded by the field team and ArcGIS software was used for mapping. Results: A total number of 335 hot spots were identified in four cities of them, 70 (20.9%) were in Ahvaz, 90 (26.9%) in Sari, 67 (20%) in Yazd and 108(32.2%) in district 2 of Tehran metropolitan. We identified nine high-density areas for PWUDs of them three were in Ahvaz, one in the south of Sari, two in district 2 of Tehran and three in Yazd. The total numbers of 1524 key informants were interviewed by the field team in 335 identified hot spots. Based on the median estimated number of PWUD, Ahvaz had the highest estimated number of PWUD (1242, range, 606-1285), followed by Sari (788, range, 373-1044), district 2 of Tehran (684, range, 642-728) and Yazd (123, range, 76-316). The median estimated number of PWID indicated that Ahvaz had the highest estimated number of PWID (843, range, 703-887), followed by Sari (346, range, 307-666), Yazd (228, range, 221-471) and Tehran (18, range, 18-34). Conclusions: Findings highlight the importance of geographical targeting of illicit drug users to provide harm reduction programs with a broader reach in Iran.