Expanded syringe exchange programs and reduced HIV infection among new injection drug users in Tallinn, Estonia

Uusküla, Anneli; Jarlais, Don C. Des; Kals, Mart; Rüütel, Kristi; Abel-Ollo, Katri; Talu, Ave; Sobolev, I. A.

doi:10.1186/1471-2458-11-517

Cited by 26 publications

(26 citation statements)

References 36 publications

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“…Two in Tallinn, Estonia, reported an HIV incidence rate of 31/100 person-years (PY) in 2004, decreasing to 9/100 PY in 2009 among people injecting for less than 3 years 47 48. The other from St. Petersburg, Russia, reported a rate of 4.5/100 PY 49…”

Section: Resultsmentioning

confidence: 99%

HIV among people who inject drugs in Central and Eastern Europe and Central Asia: a systematic review with implications for policy

et al. 2012

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Background and objectivesHIV among people who inject drugs (PWID) is a major public health concern in Eastern and Central Europe and Central Asia. HIV transmission in this group is growing and over 27 000 HIV cases were diagnosed among PWID in 2010 alone. The objective of this systematic review was to examine risk factors associated with HIV prevalence among PWID in Central and Eastern Europe and Central Asia and to describe the response to HIV in this population and the policy environments in which they live.DesignA systematic review of peer-reviewed and grey literature addressing HIV prevalence and risk factors for HIV prevalence among PWID and a synthesis of key resources describing the response to HIV in this population. We used a comprehensive search strategy across multiple electronic databases to collect original research papers addressing HIV prevalence and risk factors among PWID since 2005. We summarised the extent of key harm reduction interventions, and using a simple index of ‘enabling’ environment described the policy environments in which they are implemented.Studies reviewedOf the 5644 research papers identified from electronic databases and 40 documents collected from our grey literature search, 70 documents provided unique estimates of HIV and 14 provided multivariate risk factors for HIV among PWID.ResultsHIV prevalence varies widely, with generally low or medium (<5%) prevalence in Central Europe and high (>10%) prevalence in Eastern Europe. We found evidence for a number of structural factors associated with HIV including gender, socio-economic position and contact with law enforcement agencies.ConclusionsThe HIV epidemic among PWID in the region is varied, with the greatest burden generally in Eastern Europe. Data suggest that the current response to HIV among PWID is insufficient, and hindered by multiple environmental barriers including restricted access to services and unsupportive policy or social environments.

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Section: Resultsmentioning

confidence: 99%

HIV among people who inject drugs in Central and Eastern Europe and Central Asia: a systematic review with implications for policy

et al. 2012

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“…39 These methods have been used in other recent studies. 40,41 Two opposing factors were considered when deciding which PWID to include in estimates of incidence. Including PWID with more years injecting increases sample size and allows for examination of a key assumption.…”

Section: Methodsmentioning

confidence: 99%

HIV Prevalence, Estimated Incidence, and Risk Behaviors Among People Who Inject Drugs in Kenya

Kurth

Cleland

Jarlais

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Objective HIV infection in sub-Saharan Africa increasingly occurs among people who inject drugs (PWID). Kenya is one of the first to implement a national needle and syringe program (NSP). Our study undertook a baseline assessment as part of evaluating NSP in a seek, test, treat, and retain approach. Methods Participants enrolled May–December 2012 from 10 sites. Respondent-driven sampling was used to reach n=1,785 PWID for HIV-1 prevalence and viral load determination and survey data. Results Estimated HIV prevalence, adjusted for differential network size and recruitment relationships, was 14.5% in Nairobi (95% CI 10.8–18.2) and 20.5% in the Coast region (95% CI 17.3–23.6). Viral load (log10 transformed) in Nairobi ranged from 1.71 to 6.12 (median 4.41; IQR 3.51–4.94) and in the Coast from 1.71 to 5.88 (median 4.01; IQR 3.44–4.72). Using log10 viral load 2.6 as a threshold for HIV viral suppression, the percentage of HIV-infected participants with viral suppression was 4.2% in Nairobi and 4.6% in the Coast. Heroin was the most commonly injected drug in both regions, used by 93% of participantsin the past month typically injecting 2–3 times/day. Receptive needle/syringe sharing at last injection was more common in Nairobi (23%) than the Coast (4%). Estimated incidence among new injectors was 2.5/100 person-years in Nairobi and 1.6/100 person-years in the Coast. Conclusion The HIV epidemic is well-established among PWID in both Nairobi and Coast regions. Public health scale implementation of combination HIV prevention has the potential to greatly limit the epidemic in this vulnerable and bridging population.

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“…(Vorobjov, Uuskula, Abel-Ollo, Talu, Ruutel, et al, 2009) The expansion of NSPs and increases in syringe coverage was associated with a significant reduction in HIV incidence among PWID, from 21/100 PYO to 9/100 PYO between 2005 and 2009. (Jarlais, Feelemyer, Modi, Abdul-Quader, & Hagan, 2013; Uuskula, et al, 2011) Yet recent injectors still have a high HCV incidence (77/100 PYO) (A Uuskula, DC Des Jarlais, personal communication).…”

Section: Estoniamentioning

confidence: 99%

An international perspective on using opioid substitution treatment to improve hepatitis C prevention and care for people who inject drugs: Structural barriers and public health potential

Perlman

Jordan

Uusküla

et al. 2015

International Journal of Drug Policy

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People who inject drugs (PWID) are central to the hepatitis C virus (HCV) epidemic. Opioid substitution treatment (OST) of opioid dependence has the potential to play a significant role in the public health response to HCV by serving as an HCV prevention intervention, by treating non-injection opioid dependent people who might otherwise transition to non-sterile drug injection, and by serving as a platform to engage HCV infected PWID in the HCV care continuum and link them to HCV treatment. This paper examines programmatic, structural and policy considerations for using OST as a platform to improve the HCV prevention and care continuum in 3 countries—the United States, Estonia and Viet Nam. In each country a range of interconnected factors affects the use OST as a component of HCV control. These factors include 1) that OST is not yet provided on the scale needed to adequately address illicit opioid dependence, 2) inconsistent use of OST as a platform for HCV services, 3) high costs of HCV treatment and health insurance policies that affect access to both OST and HCV treatment, and 4) the stigmatization of drug use. We see the following as important for controlling HCV transmission among PWID: 1) maintaining current HIV prevention efforts, 2) expanding efforts to reduce the stigmatization of drug use, 3) expanding use of OST as part of a coordinated public health approach to opioid dependence, HIV prevention, and HCV control efforts, 4) reductions in HCV treatment costs and expanded health system coverage to allow population level HCV treatment as prevention and OST as needed. The global expansion of OST and use of OST as a platform for HCV services should be feasible next steps in the public health response to the HCV epidemic, and is likely to be critical to efforts to eliminate or eradicate HCV.

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Expanded syringe exchange programs and reduced HIV infection among new injection drug users in Tallinn, Estonia

Cited by 26 publications

References 36 publications

HIV among people who inject drugs in Central and Eastern Europe and Central Asia: a systematic review with implications for policy

HIV among people who inject drugs in Central and Eastern Europe and Central Asia: a systematic review with implications for policy

HIV Prevalence, Estimated Incidence, and Risk Behaviors Among People Who Inject Drugs in Kenya

An international perspective on using opioid substitution treatment to improve hepatitis C prevention and care for people who inject drugs: Structural barriers and public health potential

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