Reshaping addiction harm reduction program in Iran: The Ministry of Health's journey from reactive measures to strategic optimization.

Iran's national harm reduction program, scaled up during a period of substantial decline in HIV prevalence among people who inject drugs, later faced growing operational challenges as client numbers declined at many service sites. This Comment describes the evidence-based restructuring undertaken by the Ministry of Health and Medical Education (MoHME) after approximately two decades of implementation. National studies on population size estimation, geospatial distribution of injecting drug use, and service quality assessment informed a major reconfiguration of the harm reduction network. Underutilized facilities were consolidated, while outreach teams and mobile clinics were repositioned toward underserved areas and emerging drug-use hotspots. The restructuring aimed to improve resource utilization, maintain national coverage, and better align services with changing patterns of drug use and emerging hotspots. Iran's experience highlights the importance of continuous evaluation and adaptation of mature harm reduction programs in response to epidemiological transitions, evolving substance-use patterns, and emerging evidence. The lessons from this process may be relevant for other countries seeking to optimize publicly funded harm reduction services while preserving access for vulnerable populations.