Abstract

BackgroundDrug injection has been increasing over the past decades all over the world. Hepatitis B and C viruses (HBV and HCV) are two common infections among people who inject drugs (PWID) and more than 60% of new human immunodeficiency virus (HIV) cases are PWID. Thus, investigating risk factors associated with drug use transition to injection is essential and was the aim of this research.MethodsWe used a database from drug use treatment centers in Kermanshah Province (Iran) in 2013 that included 2098 records of people who use drugs (PWUD). The information of 29 potential risk factors that are commonly used in the literature on drug use was selected. We employed four classification methods (decision tree, neural network, support vector machine, and logistic regression) to determine factors affecting the decision of PWUD to transition to injection.ResultsThe average specificity of all models was over 84%. Support vector machine produced the highest specificity (0.9). Also, this model showed the highest total accuracy (0.91), sensitivity (0.94), positive likelihood ratio [1] and Kappa (0.94) and the smallest negative likelihood ratio (0). Therefore, important factors according to the support vector machine model were used for further interpretation.ConclusionsBased on the support vector machine model, the use of heroin, cocaine, and hallucinogens were identified as the three most important factors associated with drug use transition injection. The results further indicated that PWUD with the history of prison or using drug due to curiosity and unemployment are at higher risks. Unemployment and unreliable sources of income were other suggested factors of transition in this research.

Highlights

  • Drug injection has been increasing over the past decades all over the world

  • We used C5.0 decision tree that can automatically winnow the variables before a classifier is constructed, discarding those that appear to be only marginally relevant

  • We modeled a logistic regression based on six major variables as independent variables that had importance greater than 0.05 and history of drug injection as dependent variable

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Summary

Introduction

Hepatitis B and C viruses (HBV and HCV) are two common infections among people who inject drugs (PWID) and more than 60% of new human immunodeficiency virus (HIV) cases are PWID. Drug injection has been increasing over the past decades all over the world [2]. A systematic review of HIV among people who use drugs (PWUD) showed that the prevalence of HIV among PWID is 4.4 times more than others [6]. A third of all HIV cases outside of sub-Saharan Africa are PWID [7]. This infection can spread to other groups of society via sexual relationships with PWID. In seven out of ten areas under the coverage of the joint United Nations’ program on HIV and AIDS (UNAIDS), drug injection was identified as the first (or second) cause of HIV transmission [8, 9]

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