Mapping and population size estimates of people who inject drugs in Afghanistan in 2019: Synthesis of multiple methods

Abstract

Introduction Mapping and population size estimates of people who inject drugs (PWID) provide information needed for monitoring coverage of programs and planning interventions. The objectives of this study were to provide the locations and numbers of PWID in eight cities in Afghanistan and extrapolate estimates for the country as a whole. Methods Multiple population size estimation methods were used, including key informant interviews for mapping and enumeration with reverse tracking, unique object and service multipliers, capture-recapture, and wisdom of the crowds. The results of the several methods were synthesized using the Anchored Multiplier–a Bayesian approach to produce point estimates and 95% credible intervals (CI). Using the prevalence of PWID in the eight cities and their correlation with proxy indicators, we extrapolated the PWID population size for all of Afghanistan. Results Key informants and field mapping identified 374 hotspots across the eight cities from December 29, 2018 to March 20, 2019. Synthesizing results of the multiple methods, the number of male PWID in the eight study cities was estimated to be 11,506 (95% CI 8,449–15,093), corresponding to 0.69% (95% CI 0.50–0.90) of the adult male population age 15–64 years. The total number of women who injected drugs was estimated at 484 (95% CI 356–633), corresponding to 0.03% (95% CI 0.02–0.04) of the adult female population. Extrapolating by proxy indicators, the total number of PWID in Afghanistan was estimated to be 54,782 (95% CI 40,250–71,837), men and 2,457 (95% CI 1,823–3,210) women. The total number of PWID in Afghanistan was estimated to be 57,207 (95% CI 42,049–75,005), which corresponds to 0.37% (95% CI 0.27–0.48) of the adult population age 15 to 64 years. Discussion This study provided estimates for the number of PWID in Afghanistan. These estimates can be used for advocating and planning services for this vulnerable at-risk population.

Understanding injecting drug use in Afghanistan: A scoping review

“…Eleven studies (10 quantitative and 2 qualitative) described the drug use characteristics of PWID [ 14 , 49 , 53 , 54 , 58 , 59 , 61 , 64 , 67 – 69 ]. Heroin was the most common drug used [ 14 , 51 , 54 , 61 , 67 – 69 ]. Some studies reported opium as the second most common drug used among PWID [ 14 , 67 , 68 ].…”

“…Heroin was the most common drug used [ 14 , 51 , 54 , 61 , 67 – 69 ]. Some studies reported opium as the second most common drug used among PWID [ 14 , 67 , 68 ]. Polydrug use was common [ 49 , 54 , 61 , 68 , 69 ] with 20–77% of participants reporting mixing heroin with pheniramine maleate (Avil) [ 49 , 54 , 61 , 69 ].…”

Factors Associated with HIV Risk and Vulnerability Among Injecting Drug Users in Afghanistan: A Narrative Review

“…Injecting drug use has increasingly become an important cause of HIV transmission in the world including Afghanistan. 17 , 36 Although the HIV prevalence among the general population in Afghanistan is still low (<0.1%), but the UNAIDS data indicates that the number of people living with HIV has been increasing mainly attributed to IDU. 10 , 11 This study meant to explore the HIV risk and vulnerability factors among IDUs who are the most affected group in Afghanistan.…”

“…16 A study by Rasheed et al in 2019 estimated Afghanistan’s total number of IDUs 57,207 people indicating a significant increase. 17 …”

“…16 A study by Rasheed et al in 2019 estimated Afghanistan's total number of IDUs 57,207 people indicating a significant increase. 17 The first Integrated biological and behavioral surveillance (IBBS) in 2009 which studied IDUs in three cities of Afghanistan (Kabul, Herat, Mazar-i-Sharif) reported an average 7.4% HIV prevalence among them. 18 The second and last round of the IBBS in 2012, which covered IDUs in five cities (Kabul, Herat, Mazar-i-Sharif, Jalalabad, and Charikar) reported the average HIV prevalence among them 4.4% ranging from 0.3% in Mazar-i-Sharif, 0.9% in Charikar, 1.0% in…”