Don Des Jarlais

Don Des Jarlais
Don Des Jarlais
Scroll

Professor of Epidemiology

Professional overview

Dr. Don Des Jarlais is a leader in the fields of AIDS and injecting drug use, and has published extensively on these topics including articles in The New England Journal of Medicine, JAMA, Science, and Nature.

He is active in international research, having collaborated on studies in many different countries.  He serves as a consultant to various institutions, including the U.S. Centers for Disease Control and Prevention, the National Institute of Drug Abuse, the National Academy of Sciences, and the World Health Organization.

Dr. Des Jarlais’ research has received numerous awards, including a New York State Department of Health Commissioner’s award for promoting the health of persons who use drugs.  He formerly served as avcommissioner for the National Commission on AIDS; as a core group member of the UNAIDS Reference Group on HIV and Injecting Drug Use; and as a member of the President’s Emergency Plan for AIDS Relief (PEPFAR) Scientific Advisory Board.

Dr. Des Jarlais is also an adjunct faculty of psychiatry and preventive medicine at Icahn School of Medicine at Mount Sinai, and guest investigator at Rockefeller University in New York.

Education

BA, Behavioral Science, Rice University, Houston, TX
PhD, Social Psychology, University of Michigan, Ann Arbor, MI

Areas of research and study

Epidemiology
HIV/AIDS
Psychology

Publications

Publications

Hepatitis C treatment outcomes among people who inject drugs experiencing unstable versus stable housing: Systematic review and meta-analysis

Mortality among people who inject drugs - the interwoven roles of fentanyl and HIV: a community-based cohort study

Utility of self-report antiretroviral adherence for predicting HIV viral load among persons who inject drugs in Hai Phong Vietnam: assessing differences by methamphetamine use

Feelemyer, J., Des Jarlais, D. C., Nagot, N., Huong, D. T., Oanh, K. T. H., Khue, P. M., Thi Giang, H., Tuyet Thanh, N. T., Cleland, C. M., Arasteh, K., Caniglia, E., Chen, Y., Bart, G., Moles, J. P., Vinh, V. H., Vallo, R., Quillet, C., Rapoud, D., Le, S. M., … Khan, M. R. (n.d.).

Publication year

2024

Journal title

AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV

Volume

36

Issue

4

Page(s)

553-560
Abstract
Abstract
In resource-limited settings, alternatives to HIV viral load testing may be necessary to monitor the health of people living with HIV. We assessed the utility of self-report antiretroviral therapy (ART) to screen for HIV viral load among persons who inject drugs in Hai Phong Vietnam, and consider differences by recent methamphetamine use. From 2016 to 2018 we recruited PWID through cross sectional surveys and collected self-report ART adherence and HIV viral load to estimate sensitivity, specificity, positive and negative predictive values (PPV, NPV) and likelihood ratios (LR+, LR-) for self-reported ART adherence as a screening test for HIV viral load. We used three HIV viral load thresholds: < 1000, 500 and 250 copies/mL; laboratory-confirmed HIV viral load was the gold standard. Among 792 PWID recruited, PPV remained above 90% regardless of recent methamphetamine use with slightly higher PPV among those not reporting recent methamphetamine use. The results remained consistent across all three HIV viral load thresholds. Our findings suggest that when HIV viral load testing is not possible, self-reported ART adherence may inform decisions about how to prioritize HIV viral load testing among PWID. The high PPV values suggest self-reported high ART adherence indicates likely HIV viral suppression, irrespective of methamphetamine use.

“I Didn’t Know What They’re Gonna Do to Me: So That’s Why I Said No”: Why Youth Decline HIV Testing in Emergency Departments

A community-based strategy to eliminate hepatitis C among people who inject drugs in Vietnam

Failed generating bibliography.

Publication year

2023

Journal title

The Lancet Regional Health - Western Pacific

Volume

37
Abstract
Abstract
Background: Towards hepatitis C elimination among people who inject drugs (PWID), we assessed the effectiveness of a strategy consisting of a community-based respondent-driven sampling (RDS) as wide screening, a simplified and integrated hospital-based care, and prevention of reinfection supported by community-based organisations (CBO), in Hai Phong, Vietnam. Methods: Adults who injected heroin were enrolled in a RDS survey implemented in two CBO premises. Rapid HIV and HCV tests were done on site, and blood was taken for HCV RNA testing. Those with detectable HCV RNA were referred with CBO support to three public hospitals for 12-week sofosbuvir/daclatasvir, plus ribavirin for patients with cirrhosis. Participants were followed-up 12 weeks post-treatment (SVR12) and 48 weeks after enrolment. The primary endpoint was the rate of undetectable HCV RNA participants at 48 weeks. Findings: Among the 1444 RDS survey participants, 875 had hepatitis C. Their median age was 41 years (IQR 36–47), 96% were males, 36% were HIV-coinfected. Overall, 686 (78.4%) started sofosbuvir/daclatasvirs, and 629 of the 647 (97.2%) patients tested at SVR12 were cured. At week 48 (581/608) 95.6% had undetectable HCV RNA, representing 66.4% of all PWID identified with hepatitis C. The reinfection rate after SVR12 was 4/100 person-years (95% CI: 2–7). Interpretation: Our strategy, involving CBO and addressing all steps from wide HCV screening to prevention of reinfection, stands as a promising approach to eliminate HCV among PWID in low and middle-income countries. Funding: France ANRS|MIE ( #ANRS12380). The RDS survey was implemented with grants from the NIDA ( #R01DA041978) and ANRS|MIE ( #ANRS12353).

Adapted “Break the Cycle for Avant Garde” intervention to reduce injection assisting and promoting behaviours in people who inject drugs in Tallinn, Estonia: A pre- post trial

Association between recent methamphetamine use, antiretroviral therapy and HIV viral load; a mediation analysis from a cohort of HIV positive persons who inject drugs in Hai Phong, Vietnam

Awareness and willingness to use HIV self-testing among people who inject drugs in Iran

Khezri, M., Goldmann, E., Tavakoli, F., Karamouzian, M., Shokoohi, M., Mehmandoost, S., Ghalekhani, N., Haghdoost, A. A., Des Jarlais, D., Mirzazadeh, A., & Sharifi, H. (n.d.).

Publication year

2023

Journal title

Harm Reduction Journal

Volume

20

Issue

1
Abstract
Abstract
Background: Most people who inject drugs (PWID) in Iran have not undergone recent HIV testing. While PWID face barriers when seeking HIV testing at health facilities, HIV self-testing (HIVST) could be a promising approach to improve HIV testing uptake. We examined the awareness and willingness to use HIVST among PWID in Iran. We also identified participants’ characteristics associated with a higher willingness to use HIVST. Methods: PWID were recruited in 11 cities using a respondent-driven sampling method. Willingness to use HIVST was defined as a binary variable (very low/low willingness vs. high/very high willingness). We performed multivariable modified Poisson regression to examine associated factors and report adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). Results: Of 2,252 PWID, 362 (16.2%; 95% CI 14.7, 17.8) had ever heard of HIVST; however, 1,658 (73.6%; 95% CI 71.7, 75.4) reported high/very high willingness to use HIVST. Willingness to use HIVST was higher among PWID who reported having a high/moderate HIV risk perception (aPR 1.22; 95% CI 1.09, 1.37), ever experiencing homelessness (aPR 1.15; 95% CI 1.03, 1.28), > 10 years of injecting history (aPR 1.16; 95% CI 1.00, 1.34), and high injection frequency in the last three months (aPR 1.18; 95% CI 1.05, 1.32). Conclusion: Most PWID in Iran, particularly those experiencing homelessness, have a longer injecting history, engage in more frequent injection practices, and possess a heightened perception of HIV risk would be willing to adopt HIVST. Enhancing HIVST awareness through increased access to HIVST and health education programs are needed. Additionally, conducting implementation science studies to effectively design and run HIVST programs in Iran can also increase PWID’s access to HIV testing.

COVID-19 stigmatization after the development of effective vaccines: Vaccination behavior, attitudes, and news sources

Des Jarlais, D. C., Lieff, S., Grivel, M., Meltzer, G., Choi, J., Weng, C. A., Feelemyer, J. P., Chang, V. W., & Yang, L. (n.d.).

Publication year

2023

Journal title

PloS one

Volume

18

Issue

4
Abstract
Abstract
Objective To compare COVID-19 stigmatization at two pandemic time points (1) August 2020—during lockdowns and prior to vaccine rollout, and (2) May 2021—during vaccine rollout, when approximately half of U.S. adults were vaccinated. Methods Comparison of COVID19-related stigmatization and associated factors in two national internet surveys conducted in August 2020 (N = 517) and May 2021 (N = 812). Factors associated with endorsing stigmatization were identified using regression analysis. The main outcomes included endorsement of stigmatization and behavioral restrictions towards persons with COVID-19 and towards persons of Chinese descent. A previously developed “stigmatizing attitudes and behavioral restrictions” scale was adapted to measure the intersection of negative attitudes toward COVID-19 disease and negative attitudes toward persons of Chinese descent. Results COVID-19 related stigmatization declined significantly from August 2020 to May 2021. Many factors were associated with stigmatizing in both surveys: full time employment, Black race, Hispanic ethnicity, worry about contracting COVID-19, probable depression, and Fox News and social media as sources of information (all positively associated), and self-assessed knowledge about COVID-19, contact with Chinese individuals, and publicly funded news as sources (all negatively associated). Positive attitudes toward vaccination were associated with stigmatization. Conclusions COVID-19 related stigmatization reduced substantially over these two points in the pandemic, with many continuities in the factors associated with stigmatizing. Despite the reduction in stigmatizing, however, some stigmatizing attitudes for both COVID-19 and Chinese individuals remained.

COVID-19 vaccination and HIV transmission among persons who inject drugs during the first two years of the COVID-19 pandemic in New York City

Field Testing the “Avoid the Needle” Intervention for Persons at Risk for Transitioning to Injecting Drug Use in Tallinn, Estonia and New York City, USA

Gender Differences in HIV, HCV risk and Prevention Needs Among People who Inject drug in Vietnam

Gender, homelessness, hospitalization and methamphetamine use fuel depression among people who inject drugs: implications for innovative prevention and care strategies

Moulis, L., Le, S. M., Hai, V. V., Huong, D. T., Minh, K. P., Oanh, K. T. H., Rapoud, D., Quillet, C., Thi, T. T. N., Vallo, R., Hoang, G. T., Moles, J. P., Laureillard, D., Feelemyer, J., Des Jarlais, D. C., Michel, L., & Nagot, N. (n.d.).

Publication year

2023

Journal title

Frontiers in Psychiatry

Volume

14
Abstract
Abstract
Background: The co-occurrence of substance use disorder and mental disorder, known as dual diagnosis, has a distressingly high prevalence among individuals grappling with either of these conditions. Mood disorders, especially depression, constitute a substantial burden for People Who Inject Drugs (PWID) and a significant public health concern in Vietnam. Identifying risk factors for depression in PWID is imperative for the development of targeted interventions. Methods: We enrolled PWID into a cohort using the respondent-driven sampling method. Over a 36-month period, we systematically tracked the emergence of depression and employed multiple imputation in conjunction with a mixed nonlinear model to pinpoint risk factors for depression in this demographic. At inclusion, depression was screened using the PHQ-2 questionnaire, and subsequent episodes of depression were assessed semi-annually using the CES-D8. Results: Three hundred and ninety-one PWID (26.6%) were depressed. Major risk factors for depression included being female, not having a permanent residency, having been hospitalized and using methamphetamine more than weekly. Other risk factors included age, being single, not having a health insurance card and not being on methadone. Limitations: The exclusion of missing visits and social desirability could have led to selection and information biases. In this observational study, confusion biases are possible despite our best efforts. Conclusion: Depression is alarmingly frequent in PWID. In this study taking in account the chronological relationship between sociodemographic and clinical factors and depression, risk factors were identified in this specific setting of low-to-middle income country. The findings highlight the need to develop innovative targeted psychiatric interventions with the help of supporting peers.

Global epidemiology of abortion among female sex workers: a systematic review, meta-analysis, and meta-regression

HCV RNA Quantification by a Domestic Commercial Assay: A Case Study among People Who Inject Drugs in Vietnam

HIV risk and prevention among clients of a delivery-based harm reduction service during an HIV outbreak among people who use drugs in northern rural Minnesota, USA

HIV treatment, antiretroviral adherence and AIDS mortality in people who inject drugs: a scoping review

Impact of COVID-19 &amp; Response Measures on HIV-HCV Prevention Services and Social Determinants in People Who Inject Drugs in 13 Sites with Recent HIV Outbreaks in Europe, North America and Israel

Wiessing, L., Sypsa, V., Abagiu, A. O., Arble, A., Berndt, N., Bosch, A., Buskin, S., Chemtob, D., Combs, B., Conyngham, C., Feelemyer, J., Fitzgerald, M., Goldberg, D., Hatzakis, A., Patrascu, R. E., Keenan, E., Khan, I., Konrad, S., Leahy, J., … Des Jarlais, D. (n.d.).

Publication year

2023

Journal title

AIDS and Behavior

Volume

27

Issue

4

Page(s)

1140-1153
Abstract
Abstract
HIV/HCV prevention among people who inject drugs (PWID) is of key public health importance. We aimed to assess the impact of COVID-19 and associated response measures on HIV/HCV prevention services and socio-economic status of PWID in high-HIV-risk sites. Sites with recent (2011–2019) HIV outbreaks among PWID in Europe North America and Israel, that had been previously identified, were contacted early May 2020. Out of 17 sites invited to participate, 13 accepted. Semi-structured qualitative site reports were prepared covering data from March to May 2020, analyzed/coded and confirmed with a structured questionnaire, in which all sites explicitly responded to all 103 issues reported in the qualitative reports. Opioid maintenance treatment, needle/syringe programs and antiretroviral treatment /hepatitis C treatment continued, but with important reductions and operational changes. Increases in overdoses, widespread difficulties with food and hygiene needs, disruptions in drug supply, and increased homelessness were reported. Service programs rapidly reformed long established, and politically entrenched, restrictive service delivery policies. Future epidemic control measures should include mitigation of negative side-effects on service provision and socio-economic determinants in PWID.

Incarceration history is associated with HIV infection among community-recruited people who inject drugs in Europe: A propensity-score matched analysis of cross-sectional studies

Provider Perspectives on Barriers to Routine HIV Testing of Adolescent and Young Adult Patients in Emergency Department Settings

Socioeconomic and racial/ethnic spatial polarization and incarceration among people who inject drugs in 19 US metropolitan areas, 2015

Syringe Service Program Perspectives on Barriers, Readiness, and Programmatic Needs to Support Rollout of the COVID-19 Vaccine

The first city

Des Jarlais, D. C., Friedman, S. R., & Sotheran, J. L. (n.d.). In AIDS: HIV among intravenous drug users in New York City (1–).

Publication year

2023

Page(s)

279-295

Understanding intentionality of fentanyl use and drug overdose risk: Findings from a mixed methods study of people who inject drugs in New York City

A community-based intervention to decrease the prevalence of HIV viremia among people who inject drugs in Vietnam

Duong, H. T., Moles, J. P., Pham, K. M., Vallo, R., Hoang, G. T., Vu, V. H., Khuat, O. T. H., Nham, T. T. T., Nguyen, D. Q., Quillet, C., Rapoud, D., Van De Perre, P., Castellani, J., Feelemyer, J., Michel, L., Laureillard, D., Jarlais, D. D., & Nagot, N. (n.d.).

Publication year

2022

Journal title

The Lancet Regional Health - Western Pacific

Volume

27
Abstract
Abstract
Background: In most low-to-middle-income countries, HIV control at the population level among people who inject drugs (PWID) remains a major challenge. We aimed to demonstrate that an innovative intervention can identify HIV-positive PWID in the community who are not treated efficiently, and get them treated efficiently. Methods: Between 2016 and 2020, we implemented an intervention consisting of mass HIV screening of PWID using three annual respondent-driven sampling surveys (RDSS) and a post-intervention evaluation RDSS in community-based organisation (CBO) sites, coupled with peer support to facilitate/improve access to antiretroviral and methadone therapy in Haiphong, Vietnam. The primary outcome was the proportion of identified uncontrolled HIV-positive PWID who achieved viral control. We also estimated the potential effect of the intervention on the proportion of PWID with HIV RNA >1000 copies/mL among all PWID during the study period. Findings: Over the three RDSS, 3150 different PWID were screened, i.e. two-thirds of the estimated population size. They all injected heroin, their median age was of 39 years, 95% were male, 26.5% were HIV-infected, and 78.6% of the latter had HIV RNA ≤1000 copies/mL. Among the 177 PWID identified with an unsuppressed viral load, 73 (41.2%) achieved viral suppression at the final visit. HIV viremia decreased from 7.2% at baseline to 2.9% at the final RDSS (p<0.001). Up to 42% of this observed reduction may be explained by the intervention, in the absence of any external intervention targeting PWID during the study period. Interpretation: Mass community-based screening using RDSS coupled with CBO support is a powerful tool to rapidly identify untreated HIV-positive PWID and (re)link them to care. Funding: NIDA (USA) and ANRS (France).

Contact

don.desjarlais@nyu.edu 708 Broadway New York, NY, 10003