Management of substance abuse

WHO drug injection study phase II

Drug injecting


Injection drug use (IDU) plays an important role in the global HIV/AIDS epidemic. Recent statistics show that in 2003, HIV infection associated with IDU transmission has been reported in more than 130 countries. In some countries in Asia and Central and Eastern Europe, IDU is now the main mode of transmission of HIV. The negative health consequences of IDU are not limited to just HIV infection. Sharing injection equipment carries a high risk of transmission of other blood-borne infectious diseases such as hepatitis B and hepatitis C.

As a result of international concern over HIV infection associated with injection drug use, in 1989, the World Health Organization initiated an international comparative study with the aim to inform national policies and practices as well as improve the understanding of HIV-related risk behaviours of injection drug users (IDUs) across the globe. The study that involved 13 cities in 10 countries was the largest international project of its kind. Apart from the wealth of data collected, the study contributed much to the development of research methods, informing national policies, establishing international collborative networks and placing drug injection, and HIV and related health policy issues on the international agenda.

The WHO Drug Injection Study Phase I resulted in recommendations to develop rapid assessment methodology, focus on 'new' HIV epidemics and other health consequences of injection drug use (as hepatitis B, C and overdoses) and link research to policy and intervention development. These recommendations shaped a design of the WHO Drug Injection Study Phase II that has been implemented since 2000 under overall coordination of the WHO Department of Mental Health and Substance Dependence with financial support from UNAIDS.

Aims and objectives

The aim of the study is to facilitate development of preventive strategies and interventions among injection drug users (IDUs) by implementing action-oriented research on the context, patterns and health consequences of drug injection behaviour in less-resourced countries.

The primary objectives of the study:

  • Determine the context, extent and patterns of high-risk behaviours among IDUs in developing/transitional countries.
  • Determine seroprevalence of blood-borne infections (HIV, Hepatitis C and Hepatitis B) among IDUs.
  • Identify and develop effective interventions to reduce adverse health consequences associated with drug injection and explore the factors associated with transitions to less harmful ways of drug consumption.
  • Evaluate rapid assessment and response methodology on injection drug use.
  • Test and adapt the instruments for studying injection drug use in different cultural settings.

Main components of the study

  • Rapid assessment of drug injection in the cities using Rapid Assessment and Response methodology developed by WHO (IDU-RAR);
  • Behavioural and seroprevalence (HIV, hepatitis B and C) survey among IDUs in each site with half of the sample from drug treatment settings and another half from community settings (total sample - minimum 400 in each site);
  • Intervention development informed by the results of a comprehensive assessment using a combination of quantitative and qualitative methods;
  • Retrospective evaluation of Rapid Assessments on Drug Use;
  • Prospective evaluation of Rapid Assessment and Response methodology.

Participating centres

The study currently involves 14 cities in 13 countries. For specific information regarding participating centres and site investigators in each country, please click the appropriate link below:

Technical coordination of the study is provided by the Centre for Research on Drugs and Health Behaviour at the Imperial College in London, United Kingdom for the rapid assessment and response component, and the National Development and Research Institutes, Inc. in New York, USA for the survey component.

Main products

Methodology and instruments

Rapid Assessment and Response Guide on Injecting Drug Use (Draft for field testing, May 1998)

  • IDU-RAR Guide (Chinese)
  • IDU-RAR Guide (English)
  • IDU-RAR Guide (Portuguese)
  • IDU-RAR Guide (Russian)
  • IDU-RAR Guide (Spanish)

Survey instrument (questionnaire)

  • Chinese version
  • English version
  • Farsi version
  • Portuguese version
  • Russian version
  • Spanish version
  • Vietnamese version
Study outcomes