Combined prevention for persons who inject drugs in the HIV epidemic in a transitional country: the case of Tallinn, Estonia

Abstract

The study was undertaken to assess the potential effectiveness of combination HIV prevention on the very high seroprevalence epidemic among persons who inject drugs (PWID) in Tallinn, Estonia, a transitional country. Data from community-based cross-sectional (respondent driven sampling) surveys of PWID in 2005, 2007, 2009 and 2011 were used together with mathematical modeling of injection-associated HIV acquisition to estimate changes in injection-related HIV incidence during this period.Utilization of one, two or three of the interventions available in the community (needle/syringes exchange, antiretroviral treatment (ART), HIV testing, opioid substitution therapy) was reported by 42.5%, 30.5%, 11.5% of HIV+ and 34.7%, 36.4%, 5.7% of HIV- PWIDs, respectively in 2011. The modeling results suggest that the combination of needle/syringe programs and provision of ART to PWID in Tallinn substantially reduced the incidence of HIV infection in this population, from an estimated 20.7/100 person-years in 2005 to 7.5/100 person-years in 2011. In conclusion, combination prevention targeting HIV acquisition and transmission-related risks among persons who inject drugs in Tallinn has paralleled the downturn of the HIV epidemic in this population.

Engagement in HIV care and its correlates among people who inject drugs in St Petersburg, Russian Federation and Kohtla-Järve, Estonia

“…Nevertheless, in 2012 HIV population prevalence in Estonia was 1.3%, the highest in Eastern Europe . Among PWID, the estimated incidence in Tallinn, the capital, was still 7.5/100 person‐years in 2011 even though 40% of all HIV‐positive individuals were receiving care .…”

Another frontier for harm reduction: contraceptive needs of females who inject drugs in Estonia, a cross-sectional study

“…According to a global review, Estonia has one of the highest concentrations of PWID among those 15–64 years (1.5% in 2007) and a very high HIV prevalence among PWID [ 1 ]. Several studies have examined sociodemographic factors and behaviors associated with IDU in Estonia [ 19 – 23 ]. One such study documented that females who inject drugs and who have started injecting recently are in high risk of becoming infected with HIV via sexual transmission, even before IDU initiation, highlighting the need for gender-specific interventions [ 24 ].…”

Using data from respondent-driven sampling studies to estimate the number of people who inject drugs: Application to the Kohtla-Järve region of Estonia

“…Estonian syringe exchange programs (SEPs) serving PWID were launched in 1997. Since 2007, each participating injection drug user has received an average of 117 sterile syringes per year [ 25 , 26 ]. Researchers have emphasized the importance of HIV prevention programs targeting new injectors [ 27 ], and findings suggest that HIV incidence among recently initiating injectors has decreased since implementation of large-scale SEPs [ 24 ].…”