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Official websites use. Share sensitive information only on official, secure websites. The national sentinel surveillance only reports data on HIV prevalence and these data are collected exclusively from PWID in drug treatment facilities. No behavioral data are monitored as part of this surveillance system. The major objective of the survey was to describe the characteristics of community-based PWID in Songkhla to help inform the development of evidence-based interventions and a more robust surveillance system. This cross-sectional IBBS survey was commenced during March to October at a methadone treatment clinic in Jana hospital located in Jana district of Songkhla province. Seeds were people who injected drugs in the past six months and were determined to have large diverse social networks. Seeds were diversely selected based on sex, age, type of drugs injected and methadone treatment status. A total of five seeds were selected by survey staff. Seeds provided voluntary informed consent, and provided with three referral coupons to recruit their peers. The study sample size was based on feasibility of recruitment rather than precision of the prevalence estimate. A design effect of 2. They were also agreeable and able to provide informed consent, and had a valid referral coupon. Potential participants were screened by asking them to show injection marks. PWID who were intoxicated at the time of the survey were excluded from the survey. Survey staff from the Songkhla Provincial Health Office, Jana hospital and the Ozone drop-in center were trained on RDS survey procedures, and with the assistance of a PWID peer, screened individuals arriving with a valid coupon to participate in the survey. The samples were delivered to hospital laboratory to perform HIV testing following Thai national HIV diagnostic testing guidelines using three-test algorithm. Samples were considered HIV-positive if all three tests were reactive. Urine samples were also collected for sexually transmitted infections STIs. Survey staff made appointments with participants to return to the survey site after two weeks to obtain both their HIV and STI test results. Post-test counseling was provided to participants who returned for their test results. Finally, participants were given three coupons for recruiting their peers and a compensation of Thai baht 6. Survey data from the interviews were transferred daily from the hand-held computers into a database program on the main survey computer created using MS Access and software Microsoft, Redmond, DC, USA. Characteristics of participants are shown in Table 1. Seven percent of participants reported using needles that had been used by others during their last injection. Risk behaviors included needle-sharing, injection of multiple drugs and low condom use. In Bangkok, Thailand, a report of history of drug overdose was found to be associated with a history of incarceration and poly-drug use among a community-recruited PWID Milloy et al. However, drop-in centers and peer outreach program appear under-utilized and there is a need to increase the coverage of more comprehensive community-based HIV prevention services and including information on drug overdose prevention and first aid for hard-to-reach PWID. However, it should be noted that these community-based programs were just initiated in , only about one year before this survey was conducted. In addition, we found that almost one-third of participants reported injecting multiple drugs including heroin, methamphetamine and midazolam. Even higher levels of multiple drug use have been reported in other areas of Thailand Wattana et al. A shift from heroin to methamphetamine injection has also been observed in other areas of Thailand and Southeast Asia Martin et al. Reported midazolam injection prevalence has been consistently higher in Bangkok than in others areas of Thailand, including Songkhla, as this is where midazolam distribution is focused and it is a cheap and easily accessible substitute for heroin Kerr et al. Our survey had a number of limitations. First, the findings were based on self-reported responses. Data may possibly subject to socially desirability bias especially when participants chose to complete a questionnaire through face-to-face interview with a survey staff. Nevertheless, the use of experienced and well trained staff conducting the interview, the use of a hand-held computer for participants to complete the questionnaire, and the promise to keep their confidentiality may have helped to reduce this bias. Second, it is possible that non-PWID participated because of the financial compensation available to the participants. In conclusion, the Thai MOPH and partners were able to successfully implement RDS in Songkhla as a form of integrated bio-behavioral surveillance to more effectively monitor the HIV epidemic and the programmatic response in Songkhla and elsewhere. This survey was effective at recruiting PWID who were not currently in drug treatment, and provided information about this sub-group which had not been previously available in Songkhla or Southern Thailand more generally. Given the increasing trend of poly-drug injecting use documented among both in- and out-of-treatment PWID, it is recommended a comprehensive and integrated combination intervention approach for both HIV services i. Funding for this study was provided by the Global Fund, which had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. The authors acknowledge personnel of the Bureau of Epidemiology and the following provincial partners in Songkhla including Provincial Health Office, Office of Prevention and Control Disease Region 12, Jana hospital and Ozone drop-in center for their contribution in implementing this survey. We would like to thank the Global Fund for their financial support and also all the participants for providing their time and sharing their information. Disclaimer : The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the U. Centers for Disease Control and Prevention. All authors have made substantial contributions warranting authorship on the current manuscript. Author NP designed the study, wrote the protocol and supervised the data collection. Authors SP and PT conducted the statistical analyses. Author PV contributed to the drafting and revision of the manuscript. Author MW supervised the preparation of the manuscript. As a library, NLM provides access to scientific literature. Int J Drug Policy. Published in final edited form as: Int J Drug Policy. Find articles by Prin Visavakum. Find articles by Niramon Punsuwan. Find articles by Chomnad Manopaiboon. Find articles by Sarika Pattanasin. Find articles by Panupit Thiengtham. Find articles by Suvimon Tanpradech. Find articles by Wichuda Sukwicha. Find articles by Mitchell Wolfe. Find articles by Dimitri Prybylski. Issue date May. PMC Copyright notice. The publisher's version of this article is available at Int J Drug Policy. Open in a new tab. Conflict of interest All authors have no conflicts of interest with respect to the submitted manuscript. Contributors All authors have made substantial contributions warranting authorship on the current manuscript. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Married but living separately, divorced or widowed. Type of drugs injected in past 1 month multiple responses. Number of times of injected drugs in past 1 month. Used needle having been used by others at last injection. Type of sexual partners among those having sex in past 3 months multiple responses. Used condom at last sex with any partner in past 3 months. Tested for HIV in past 12 months and knew the result. Places to get new needles in past 1 month multiple responses.