Hamid Sharifi

The Eastern Mediterranean Region (EMR) continues to face a substantial HIV burden, with increasing numbers of reported diagnoses, heterogeneous exposure patterns, and persistent AIDS-related mortality. Despite global progress, countries of EMR remain far from achieving the UNAIDS 95-95-95 targets. This analysis of regional HIV surveillance data presents trends in reported diagnoses, exposure patterns, and AIDS-related mortality across EMR countries from 2014 to 2023. We analyzed country-level aggregated HIV surveillance data submitted annually to the WHO Regional Office for the EMR from 2014 to 2023. Data included new HIV diagnoses, exposure modes, demographic characteristics, and AIDS-related deaths. Descriptive analyses were performed to assess temporal trends, country-level disparities, and reporting completeness. Newly reported HIV diagnoses in the EMR increased sevenfold, from 3,717 in 2014 to 26,314 in 2023, with men accounting for nearly three-quarters of diagnoses. Exposure data, available for 73.6% of cases in 2023, indicated heterosexual contact as the most frequently reported route, followed by injecting drug use, same-sex contact, and blood exposure, though substantial proportions remained unknown. Exposure patterns varied markedly across countries, reflecting both epidemiological context and surveillance limitations. Over the study period, 22,569 deaths were reported, with greatest numbers from Pakistan, Egypt, Saudi Arabia, and Somalia. Mortality disproportionately affected men over the study period, though sex-disaggregated data were incomplete in several settings. HIV in the EMR is characterized by rising diagnoses, heterogenous reported exposure, and significant mortality, with major reporting gaps in coverage and completeness. Strengthening surveillance systems, expanding diversified testing strategies, and scaling up culturally sensitive prevention and treatment services are critical to improve epidemic control. Regional collaboration and integration of harm reduction, sexual health, and stigma reduction strategies remain essential for improving outcomes and achieving HIV control targets.

Hypertension remains a major public health challenge, and poor medication adherence continues to limit effective blood pressure control despite the widespread availability of antihypertensive medications. This policy brief draws on evidence from a qualitative content analysis of interviews with 29 purposively selected participants to identify the factors influencing medication adherence among patients with hypertension in Iran. The findings indicate that medication adherence is shaped by a complex interaction of patient-related, sociocultural, and health system factors rather than by individual behavior alone. They also demonstrate that strengthening primary healthcare services, improving health literacy, enhancing patient-provider communication, and ensuring continuity of care are critical for supporting long-term medication adherence. Based on these findings, this policy brief recommends integrating structured medication-adherence support into routine primary healthcare, alongside coordinated educational and patient-centered strategies, to improve hypertension control and reduce the long-term burden of cardiovascular disease in Iran.

Background Female sex workers (FSWs) experience a disproportionate burden of violence shaped by structural, social, and individual factors. This study provides updated nationwide estimates of the prevalence of physical violence (PV) and sexual violence (SV) against FSWs and investigates its structural and individual drivers in Iran. Method This cross-sectional study was conducted from December 2023 to March 2024, recruiting 1516 FSWs from 13 major Iranian cities using respondent-driven sampling (RDS). Data were collected via face-to-face interviews using a standard questionnaire. The primary outcomes were self-reported experiences of PV and SV in the last 12 months. Multivariable logistic regression was used to identify associated factors. Results The RDS-weighted 12-month prevalence was 23.3% (95% CI, 20.0–26.6) for PV and 30.3% (95% CI, 26.4–34.2) for SV. In multivariable models, structural factors were strongly associated with violence. Stable housing was strongly protective against both PV (aOR, 0.38; 95% CI, 0.25–0.60) and SV (aOR, 0.35; 95% CI, 0.21–0.56). Conversely, being a street-based FSW significantly increased the odds of both PV (aOR, 1.33; 95% CI, 1.01–1.76) and SV (aOR, 1.48; 95% CI, 1.13–1.95). Experiencing recent sexually transmitted infections (STI) (PV: aOR, 1.66, 95% CI, 1.26–2.19; SV: aOR, 1.76, 95% CI, 1.36–2.29) and engaging in group sex (PV: aOR, 1.59, 95% CI, 1.08–2.34; SV: aOR, 1.99, 95% CI, 1.35–2.94) were also associated with higher odds of both forms of violence. Conclusion Violence is a major public health issue for FSWs in Iran, with important implications for HIV and STI prevention and care. The strong associations with work environment and housing underscore the need for confidential, stigma-free services that integrate STI/HIV care, post-violence support, and pathways to safe housing.

Background: Sexually transmitted infections (STI) are a major public health concern and can increase HIV acquisition and transmission risk. People who inject drugs (PWID) may have elevated vulnerability due to overlapping sexual, injection-related and structural risk environments. Objective: To estimate the prevalence of symptom-based STI among PWID in 2010, 2014 and 2023 and explore factors associated with STI symptom reporting among men who inject drugs (MWID) in 2023. Design: Exploratory analysis of three repeated cross-sectional national bio-behavioural surveillance surveys. Setting: Major Iranian cities. Participants: PWID aged ≥18 years who had injected in the past 12 months, resided in the study city and provided informed consent. Facility/outreach recruitment was used in 2010/2014, and respondent-driven sampling (RDS) was used in 2023. Primary outcome: Self-reported pain/burning, genital ulcers, discharge or genital warts in the past 12 months defined symptom-based STI reporting. Data were collected by structured face-to-face interviews, followed by HIV testing. Results: Symptom-based STI prevalence among PWID was stable (2010: 10.1%; 2014: 10.5%; 2023: 10.3%). Among MWID in 2023, prevalence was 8.8% (95% CI 7.26 to 10.57). STI symptom reporting was associated with HIV and Hepatitis C Virus positivity. In exploratory multivariable analysis, STI symptom reporting was associated with being separated/widowed/divorced (AOR 2.56; 95% CI 1.14 to 5.7), multiple sexual partners (AOR 4.08; 95% CI 1.22 to 13.65), unprotected sex with casual partners (AOR 2.41; 95% CI 1.27 to 4.58), ever experienced sex with men (AOR 2.98; 95% CI 1.36 to 6.54), stimulant injection (AOR 2.57; 95% CI 1.08 to 6.14) and sharing injection equipment (AOR 2.84; 95% CI 1.53 to 5.27). Conclusion: Symptom-based STI remain persistent among PWID in Iran. Findings highlight the importance of supporting integrated STI prevention, testing, condom provision, syndromic management and linkage to care within harm reduction services to improve STI control among PWID. Associations should be interpreted as hypothesis-generating, not causal.

Background and Aims: Integrating services for diseases appears to improve healthcare access and outcomes. This scoping review aimed to evaluate how different countries implement the integration of HIV, viral hepatitis, and sexually transmitted infection (STI) services. Methods: This scoping review follows Arksey and O'Malley's five‐step framework. We searched PubMed, Scopus, and Web of Science until April 2025, with no limitations in languages and time. We also searched gray literature and manually searched reference lists to identify additional relevant studies. We included studies that met the eligibility requirements and extracted the information. Results: Seventy‐eight articles met the eligibility criteria. The findings indicated that most integration efforts (93.5%) follow a vertical model. Integrated services were identified in North America, East and South Asia, Western and Southern Europe, Southern Africa, Southeast and Central Australia. The most commonly integrated services were STIs and HIV programs, followed by HCV and HIV. Conclusion: While significant progress has been made in integrating services, efforts must be expanded to low‐ and middle‐income countries to reduce disease burden further and align with WHO targets. Strengthening regulatory frameworks and adopting context‐specific models could enhance the effectiveness of integration initiatives.

Background and Aims: During the COVID‐19 pandemic, mobile health (mHealth) utilization increased, especially among specific groups such as patients with dementia (PwD). This systematic review aimed to assess mHealth interventions among PwD during the COVID‐19 pandemic. Methods: This systematic review followed the PRISMA 2020 guidelines. PubMed, Scopus, and Web of Science were searched for English‐language studies published between January 2019 and November 2025. Quantitative, qualitative, and mixed‐methods studies reporting mHealth interventions for PwD during the COVID‐19 pandemic were eligible. Study selection and data extraction were independently conducted by three reviewers. A thematic synthesis based on the Unified Theory of Acceptance and Use of Technology (UTAUT) framework was conducted using ATLAS.ti version 8. Results: Of the 16,691 records identified, 13 studies met the inclusion criteria, including 7 quantitative, 3 qualitative, and 3 mixed‐methods studies conducted across 12 countries. The synthesis identified 36 drivers and 21 barriers influencing the adoption of mHealth interventions among PwD. Key drivers included perceived usefulness, ease of use, enhanced caregiver support, improved communication with healthcare professionals, and improved access to care. Major barriers comprised technical limitations, inadequate digital infrastructure, language and accessibility challenges, and limited digital literacy among caregivers. Conclusion: mHealth interventions represent feasible tools for supporting PwD during public health emergencies by enabling remote monitoring, caregiver support, and continuity of care. In practice, healthcare providers should prioritize user‐friendly mHealth solutions tailored to caregivers' digital literacy and dementia severity. At the policy level, investments in digital infrastructure, technical support, and caregiver training programs are essential to reduce adoption barriers and ensure equitable implementation of mHealth interventions.

Background/Objectives: Self-concealment is associated with greater psychological distress and decreased help-seeking engagement. This study aimed to evaluate the psychometric properties and sex invariance of the Persian Self-Concealment Scale (SCS) in Iranian adults. Methods: Participants were recruited using convenience sampling and social media advertising, targeting adults aged 18 or older who could read and understand Persian. The valid sample comprised 644 adults. Exploratory factor analysis was performed to delineate the underlying structural dimensions, followed by confirmatory factor analysis (CFA). Multi-group CFA was used to evaluate the gender invariance. Results: A one-factor exploratory solution explained 48.83% of the variance, whereas parallel analysis suggested three factors, indicating some residual multidimensionality. The initial one-factor CFA showed poor fit (RMSEA = 0.114, CFI = 0.899, TLI = 0.871). A revised one-factor model that accounted for four localized item-pair residual associations showed improved fit in Sample 2 (RMSEA = 0.062, CFI = 0.974, TLI = 0.962, N = 322) and acceptable fit when applied without further respecification to the non-overlapping Sample 1 (N = 322) internal holdout (RMSEA = 0.078, CFI = 0.960). Internal consistency was high (α = 0.896; ω = 0.897), while correlations with depression, anxiety, and stress ranged from 0.35 to 0.37, providing moderate evidence of convergent validity. Gender invariance was partially supported. Conclusions: The Persian SCS shows promising but qualified psychometric performance for research use, pending independent replication and longitudinal validation.

Background: Lung cancer remains a leading cause of cancer‐related mortality worldwide, with few effective treatment options available for advanced stages. Canakinumab, an IL‐1β inhibitor, has been investigated as a potential therapeutic agent due to its role in modulating tumor‐promoting inflammation. However, its clinical efficacy and safety in NSCLC (non‐small cell lung cancer) continue to be uncertain. Aims: We aimed to evaluate the efficacy and safety of canakinumab compared with other standard therapies in NSCLC treatment. Methods and Results: A systematic review was conducted in accordance with PRISMA guidelines. Four electronic databases (PubMed, Scopus, Web of Science, and Embase) were searched for clinical trials assessing canakinumab for NSCLC. Eligible studies included phase I–III clinical trials. The Synthesis Without Meta‐analysis (SWiM) guidelines were followed due to substantial heterogeneity in studies. Outcomes evaluated included objective response rate (ORR), progression‐free survival (PFS), overall survival (OS), major pathologic response (MPR), and treatment‐related adverse events. Five clinical trials (three phase III , one phase II , and one phase IB ) met the inclusion criteria, with sample sizes ranging from 88 to 1382 patients. The included studies evaluated canakinumab in four distinct clinical settings: adjuvant therapy after complete resection ( CANOPY ‐A), first‐line treatment in combination with pembrolizumab plus chemotherapy ( CANOPY ‐1) or spartalizumab plus chemotherapy, second‐line treatment in combination with docetaxel ( CANOPY ‐2), and neoadjuvant therapy with or without pembrolizumab ( CANOPY ‐N). Compared to standard therapies, canakinumab did not significantly improve ORR , PFS , OS , or MPR across any clinical setting. Safety analysis showed comparable adverse event rates between intervention and control groups. Conclusion: Despite its promising mechanistic rationale, Canakinumab did not show significant clinical benefits in NSCLC. Although it is generally well tolerated, its role in NSCLC treatment remains uncertain. Future research should concentrate on identifying predictive biomarkers and optimizing combination strategies to enhance its therapeutic potential.

Female sex workers (FSWs) are one of the key populations affected by HIV. In Iran, the most recent population size estimate of FSWs is nine years old. This study aimed to estimate the number of street- and venue-based FSWs, map the geographical distribution of venues, and identify the characteristics of FSWs in three cities in Iran. This cross-sectional study was conducted among FSWs in Tehran, Shiraz, and Abadan from June 2019 to March 2020. Women 15 years and older who had a history of sex with more than one man in exchange for money, drugs, services, etc., in the last 12 months were recruited to the study. The number of FSWs in each city was estimated through FSW opinions, secondary key informants' opinions, observations/enumeration of study teams, and the service multiplier method. During the mapping stage, 391 venues were identified in these cities, from where 633 FSWs were interviewed. The median (Interquartile Range) age of sex work initiation among them was 24 (20-30). The lifetime history of HIV testing was 90.3% (n = 558), and the prevalence of self-reported HIV infection was 3.0% (95% CI:1.5-4.4) among those who ever tested for HIV. The number of venue-based FSWs was 317 (95% Uncertainty Levels [UL]: 173-435) in Abadan, 415 (95% UL: 324-687) in Shiraz, and 503 (95% UL: 455-577) in Tehran. This study provides a critical estimate of the population size and characteristics of street- and venue-based FSWs in three major cities in Iran. The findings highlight the need for targeted HIV prevention and intervention strategies, given the substantial number of FSWs engaged in drug use and frequent sex with clients, and the observed prevalence of self-reported HIV infection. Moreover, the findings highlight gaps in service coverage and can guide national HIV programming to better target priority populations and allocate resources more effectively.