Don Des Jarlais
Professor of Epidemiology
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.
BA, Behavioral Science, Rice University, Houston, TXPhD, Social Psychology, University of Michigan, Ann Arbor, MI
Assessment of a psychiatric intervention at community level for people who inject drugs in a low-middle income country: the DRIVE-Mind cohort study in Hai Phong, Viet NamFailed generating bibliography.Abstract
Journal titleThe Lancet Regional Health - Western Pacific
Volume18AbstractBackground: Access to psychiatric care for people who inject drugs (PWID) is limited/absent and stigmatized in most low-middle-income countries (LMICs). Innovative interventions are needed. We aimed to describe and assess the impact of a community-based psychiatric intervention among PWID in Hai Phong, Vietnam Methods: In a cohort study with one year psychiatric follow-up, PWID diagnosed with a psychotic disorder, a major depressive episode, or suicide risk, were recruited from the wider Drug-Related Infections in ViEtnam (DRIVE) project in the city of Hai Phong. The community-based psychiatric intervention included specialized follow-up (free consultations with psychiatrists, free medication, referral to mental health department for hospitalization when necessary) and support from community-based organisations (case management, harm reduction, administrative support, linkage to HIV care, methadone maintenance treatment and mental health support). The main outcome was reduction/remission of symptoms. Access to and retention in psychiatric care, quality-of-life and stigmatization were also measured pre and post-intervention. Findings: Among the 1212 participants screened from March to May 2019, 271 met the inclusion criteria, 233 (86.3%) accepted the intervention and 170 completed the follow-up (72.9%). At inclusion, 80.6% were diagnosed with current depression, 44.7% with psychotic disorder and 42.4% with suicide risk. After a one-year follow-up, these proportions dropped to 15.9%, 21.8%, and 22.9% respectively. Quality-of-life and perceived stigma related to mental health were also significantly improved, while drug use decreased only marginally. Interpretation: Community-based psychiatric interventions are both feasible and efficient in the Vietnamese context. Similar interventions should be implemented and evaluated in other, different LMICs. Funding:: This work was supported by grants from NIDA (US) (#DA041978) and ANRS (France) (#13353). The funding agencies had no role in designing the research, data analyses, or preparation of the report.
Automated Substance Use/Sexual Risk Reporting and HIV Test Acceptance Among Emergency Department Patients Aged 13–24 YearsAronson, I. D., Zhang, J., Rajan, S., Marsch, L. A., Bugaighis, M., Ibitoye, M. O., Chernick, L. S., & Des Jarlais, D. C.
Journal titleAIDS and Behavior
Page(s)1544-1551AbstractDespite federal guidelines, many adolescents and emerging adults are not offered HIV testing by their healthcare providers. As such, many—including those who may be at high-risk for contracting HIV given their sexual and/or substance use risk—are not routinely tested. The current study examines sexual risk and substance use among emergency department patients aged 13–24 years (n = 147), who completed an automated screening as part of a tablet-based intervention designed to increase HIV testing. Twenty seven percent (n = 39) of participants chose to test for HIV after completing the tablet-based intervention. Among this sample, sexual risk was a significant independent predictor of HIV testing (χ2 = 16.50, p < 0.001). Problem substance use (e.g. trying but failing to quit) also predicted testing (χ2 = 7.43, p < 0.01). When considering these behaviors together, analyses indicated that the effect of problem substance use (ß = 0.648, p = 0.154) on testing is explained by sexual risk behavior (ß = 1.425, p < 0.01). The study’s findings underscore the value of using routine automated risk screenings to collect sensitive data from emergency department patients, followed by computer-based HIV test offers for adolescent youth. Our research indicates tablet-based interventions can facilitate more accurate reporting of sexual behavior and substance use, and can also potentially increase HIV test uptake among those at risk.
Development and assessment of a community-based screening tool for mental health disorders among people who inject drugsFailed generating bibliography.Abstract
Journal titleDrug and Alcohol Review
Page(s)697-705AbstractIntroduction: The prevalence of mental health disorders among people who use drugs is high and well documented. This hard-to-reach population faces a very low awareness and access to mental health care, especially in developing countries. The objectives of this study were to design and assess a quick screening tool (QST) that community-based organisations (CBO) could routinely apply to a Vietnamese population of people who inject drugs (PWID), in order to refer them appropriately to mental health specialists. Methods: We devised a tool that included nine questions covering anxiety, depression, suicide risk and psychotic symptomatology. Its use required no specific background and 2 h training. Specificity and sensitivity of the QST were assessed in a population of 418 PWID recruited via respondent driven sampling, using the Mini International Neuropsychiatric Interview questionnaire plus clinical evaluation as a reference standard. Acceptability was assessed using a self-administered anonymous questionnaire submitted to all CBO members who used the QST. Results: CBO members considered the QST easy to use, relevant and helpful to deal with mental health issues. Area under the curve for detection of any symptom using the QST was 0.770. The maximum sensitivity and specificity were reached with a cut-off of 2 [sensitivity was 71.1% (95% confidence interval 62.4, 78.8), specificity was 75.9% (70.5, 80.7)]. Discussion and Conclusions: The QST appeared to be both efficient and well accepted. Given the burden of mental health problems among hard-to-reach PWID in developing countries, community-based screenings such as this one could be a particularly appropriate response.
Durable Viral Suppression Among People with HIV and Problem Substance Use in the Era of Universal Antiretroviral TreatmentPaschen-Wolff, M. M., Campbell, A. N., Tross, S., Choo, T. H., Pavlicova, M., Braunstein, S., Lazar, R., Borges, C., Castro, M., Berg, H., Harriman, G., Remien, R. H., & Des Jarlais, D.
Journal titleAIDS and Behavior
Page(s)385-396AbstractThis study explored factors associated with durable viral suppression (DVS) among two groups of people living with HIV (PLWH) and problem substance use in the context of universal antiretroviral treatment initiation. Participants (N = 99) were recruited between 2014–2017 from public sexual health clinics [SHC] and a hospital detoxification unit [detox]). DVS (NYC HIV surveillance registry) was defined as two consecutive viral load tests ≤ 200 copies/mL, ≤ 90 days apart, with all other viral loads suppressed over 12 or 18 months. Detox participants were significantly older, with more unstable housing/employment, substance use severity, and longer-term HIV vs. SHC participants. Older age, opioid and stimulant use disorder were significantly associated with lower odds of DVS, while fulltime employment and stable housing were significantly associated with higher odds of DVS at 12-month follow-up. Patterns held at 18-month follow-up. Co-located substance use and HIV services, funding for supportive housing, and collaborative patient-provider relationships could improve DVS among populations with the syndemic of problem substance use, poverty, and long-term HIV.
Harm reduction and health services provided by syringe services programs in 2019 and subsequent impact of COVID-19 on services in 2020Behrends, C. N., Lu, X., Corry, G. J., LaKosky, P., Prohaska, S. M., Glick, S. N., Kapadia, S. N., Perlman, D. C., Schackman, B. R., & Des Jarlais, D. C.
Journal titleDrug and alcohol dependence
Volume232AbstractObjectives: This study describes harm reduction and health services provided by U.S syringe services programs (SSPs) in 2019 and changes in provision of those services in 2020. Methods: SSPs were invited to participate in the Dave Purchase Memorial survey in August 2020. We collected programmatic data on services provided in 2019 and at the time of the survey in 2020. We conducted descriptive analyses using Chi-square and McNemar's tests. Results: At the time of the survey, > 60% of SSPs reported increased monthly syringe and naloxone distribution and expansion of home-based and mail-based naloxone delivery in Fall 2020 compared to 2019. Approximately three-quarters of SSPs decreased or stopped providing on-site HIV and HCV testing. Nearly half of SSPs offering on-site medications for opioid use disorder (MOUD) in 2019 increased provision of MOUD in 2020. The proportion of SSPs offering on-site mental health care services and primary care services statistically significantly decreased from 2019 to Fall 2020, but telehealth offerings of these services increased. Conclusions: Many SSPs that offered health services in 2019 and remained operational in 2020 increased telehealth provision of mental health and primary care services, increased MOUD provision, and expanded harm reduction services, but most SSPs reduced or stopped on-site HIV and HCV testing. Sustaining SSP growth and innovation is paramount for preventing overdose deaths and HIV/HCV outbreaks after the deadliest year of the opioid epidemic in 2020.
How has the COVID-19 epidemic affected the risk behaviors of people who inject drugs in a city with high harm reduction service coverage in Vietnam? A qualitative investigationNguyen, T. T., Hoang, G. T., Nguyen, D. Q., Nguyen, A. H., Luong, N. A., Laureillard, D., Nagot, N., Des Jarlais, D., Duong, H. T., Nham, T. T. T., Khuat, O. T. H., Pham, K. M., Le, M. S., Michel, L., Rapoud, D., & Le, G. M.
Journal titleHarm Reduction Journal
Issue1AbstractIntroduction: The COVID-19 outbreak disproportionally affects vulnerable populations including people who inject drugs (PWID). Social distancing and stay-at-home orders might result in a lack of access to medical and social services, poorer mental health, and financial precariousness, and thus, increases in HIV and HCV risk behaviors. This article explores how the HIV/HCV risk behaviors of PWID in Haiphong, a city with high harm reduction service coverage in Vietnam, changed during the early phase of the COVID-19 pandemic, and what shaped such changes, using the risk environment framework. Method: We conducted three focus group discussions with peer outreach workers in May 2020 at the very end of the first lockdown, and 30 in-depth interviews with PWID between September and October 2020, after the second wave of infection in Vietnam. Discussions and interviews centered on the impact of the COVID-19 pandemic on their lives, and how their drug use and sexual behaviors changed as a result of the pandemic. Results: The national shutdown of nonessential businesses due to the COVID-19 epidemic caused substantial economic challenges to participants, who mostly were in a precarious financial situation before the start of the epidemic. Unsafe injection is no longer an issue among our sample of PWID in Haiphong thanks to a combination of different factors, including high awareness of injection-related HIV/HCV risk and the availability of methadone treatment. However, group methamphetamine use as a means to cope with the boredom and stress related to COVID-19 was common during the lockdown. Sharing of smoking equipment was a standard practice. Female sex workers, especially those who were active heroin users, suffered most from COVID-related financial pressure and may have engaged in unsafe sex. Conclusion: While unsafe drug injection might no longer be an issue, group methamphetamine use and unsafe sex were the two most worrisome HIV/HCV risk behaviors of PWID in Haiphong during the social distancing and lockdown periods. These elevated risks could continue beyond the enforced lockdown periods, given PWID in general, and PWID who are also sex workers in particular, have been disproportionately affected during the global crisis.
Program Adaptations to Provide Harm Reduction Services During the COVID-19 Pandemic: A Qualitative Study of Syringe Services Programs in the U.S.Frost, M. C., Sweek, E. W., Austin, E. J., Corcorran, M. A., Juarez, A. M., Frank, N. D., Prohaska, S. M., LaKosky, P. A., Asher, A. K., Broz, D., Jarlais, D. C., Williams, E. C., & Glick, S. N.
Journal titleAIDS and Behavior
Page(s)57-68AbstractSyringe services programs (SSPs) are essential to preventing injection drug use-related infections and overdose death among people who use drugs (PWUD). The novel coronavirus (COVID-19) pandemic initially impeded SSPs’ operations. To effectively support these programs, information is needed regarding SSPs’ experiences adapting their services and the challenges posed by COVID-19. We conducted qualitative interviews with leadership and staff from a sample of 31 U.S. SSPs. Respondents discussed urgent concerns including reduced reach of services, suspended HIV/hepatitis C testing, high COVID-19 risk among PWUD, and negative impacts of isolation on overdose and mental health. They also noted opportunities to improve future services for PWUD, including shifting to evidence-based distribution practices and maintaining regulatory changes that increased access to opioid use disorder medications post-pandemic. Findings can inform efforts to support SSPs in restoring and expanding services, and provide insight into SSPs’ role in engaging PWUD during the COVID-19 response and future emergencies.
Thick trust, thin trust, social capital, and health outcomes among trans women of color in New York City
A cohort study revealed high mortality among people who inject drugs in Hai Phong, VietnamVinh, V. H., Vallo, R., Giang, H. T., Huong, D. T., Oanh, K. T. H., Khue, P. M., Thanh, N. T. T., Quillet, C., Rapoud, D., Michel, L., De Perre, P. V., Feelemyer, J., Moles, J. P., Cournil, A., Jarlais, D. D., Laureillard, D., & Nagot, N.
Journal titleJournal of Clinical Epidemiology
Page(s)38-48AbstractObjective: To estimate the residual mortality rate among people who inject drugs (PWID) in a Low-Middle Income Countries context where the HIV epidemic has been controlled and methadone coverage is high. Study design and setting: PWID from Haiphong, Vietnam, were recruited through three annual respondent-driven sampling surveys that fueled two cohorts of PWID with HIV (n = 761) and without HIV (n = 897), with bi-annual follow-up. Presumed causes of death were ascertained from medical records and/or interviews of participants family. Results: Among the 1658 participants with a median follow-up of 2 years, 67 and 36 died in the HIV-positive and HIV-negative cohort, respectively, yielding crude mortality rates of 4.3 (95% Confidence interval (CI): 3.3-5.4) per 100 person-years of follow-up (PYFU) and 1.9 (CI: 1.4-2.6) per 100 PYFU. In the HIV-positive cohort, in which 81% of participants had undetectable viral load, the two main causes of death were tuberculosis and HIV-related diseases. In the HIV-negative cohort, the two main causes of death were liver-related diseases and overdose. In a time-dependent multivariable model, “unsuppressed viral load” was associated with increased risk of mortality, whereas “being on methadone” or “being employed” was associated with a lower risk. Conclusion: Despite a very successful HIV and methadone program, the mortality remains high among PWID in Vietnam, largely due to curable infectious diseases such as tuberculosis and viral hepatitis.
A Multistage Process Model of How a Person Who Currently Injects Drugs Comes to Assist Persons Who Do not Inject with Their First InjectionsDes Jarlais, D. C., Arasteh, K., Barnes, D. M., Feelemyer, J., Berg, H., Raag, M., Talu, A., Org, G., Tross, S., & Uuskula, A.
Journal titleFrontiers in Sociology
Volume6AbstractInjecting drugs for the first time almost always requires assistance from an experienced person who injects drugs (PWID). While there has been moderate amount of research on PWID who assist with first injections, most of this research has focused on identifying characteristics of PWID who assist with first injections. We do not have a formal model that describes how the minority of PWID come to assist do so, while the majority never assist. Through comparison of persons who did or did not recently assist with first injections using data from PWID in Tallinn, Estonia (N = 286) and Staten Island, New York City (N = 101), we developed a formal multi-stage model of how PWID come to assist with first injections. The model had a primary pathway 1) of engaging in “injection promoting” behaviors, 2) being asked to assist, and 3) assisting. Statistical testing using odds ratios showed participation in each stage was strongly associated with participation in the next stage (all odds ratios >3.0) and the probabilities of assisting significantly increased with participation in the successive stages. We then used the model to compare engagement in the stages pre-vs. post participation in an intervention, and to compare persons who recently assisted to persons who had assisted in the past but had not recently assisted and to persons who had never assisted. Advantages of a formal model for how current PWID come to assist with first injections include: facilitating comparisons across different PWID populations and assessing strengths and limitations of interventions to reduce assisting with first injections.
An application of agent-based modeling to explore the impact of decreasing incarceration rates and increasing drug treatment access on sero-discordant partnerships among people who inject drugsLinton, S. L., Jarlais, D. C., Ornstein, J. T., Kasman, M., Hammond, R., Kianian, B., Smith, J. C., Wolfe, M. E., Ross, Z., German, D., Flynn, C., Raymond, H. F., Klevens, R. M., Spencer, E., Schacht, J. M., Finlayson, T., Paz-Bailey, G., Wejnert, C., & Cooper, H. L.
Journal titleInternational Journal of Drug Policy
Volume94AbstractBackground: People who inject drugs (PWID) lag behind other key populations in HIV care continuum outcomes. The impacts of criminal justice reform and increasing drug treatment access on HIV have been underexplored. Methods: We developed agent-based models (ABM) of sexual partnerships among PWID and non-PWID, and injection equipment-sharing partnerships among PWID in five US cities (Baltimore, Boston, Miami, New York City, San Francisco) over 3 years. The first set of ABM projected changes in partnership discordance among PWID as a function of decreasing ZIP code-level incarceration rates. The second set projected discordance as a function of increasing ZIP code-level drug treatment access. ABM were parameterized and validated overall, and by city and PWID race/ethnicity (Black, Latino, White) using National HIV Behavioral Surveillance data, administrative ZIP code-level data, surveillance reports and prior literature. Informed by research on prisoner release and community-level HIV prevalence, reductions in incarceration rates were fixed at 5% and 30% and respectively projected to increase ZIP code-level HIV prevalence by 2% and 12%. Increases in drug treatment access were fixed at 30% and 58%. Results: In each city, a 30% reduction in ZIP code-level incarceration rates and 12% increase in ZIP code-level HIV prevalence significantly increased sero-discordance among at least one racial/ethnic group of PWID by 1–3 percentage points. A 5% reduction in incarceration rates, and 30% and 58% increases in drug treatment access, led to isolated significant changes in sero-discordance among Black and White PWID that were less than 1 percentage point. Conclusion: Reductions in incarceration rates may lead to short-term increases in sero-discordant partnerships among some PWID by increasing community-level HIV prevalence. Efforts to increase HIV testing, engagement in care and community reintegration post release, should be strengthened in the wake of incarceration reform. Additional research should confirm these findings and explore the lack of widespread impacts of drug treatment in this study.
Behavioral correlates of COVID-19 worry: Stigma, knowledge, and news sourceMeltzer, G. Y., Chang, V. W., Lieff, S. A., Grivel, M. M., Yang, L. H., & Des Jarlais, D. C.
Journal titleInternational journal of environmental research and public health
Issue21AbstractNon-adherence to COVID-19 guidelines may be attributable to low levels of worry. This study assessed whether endorsing COVID-19-stigmatizing restrictions, COVID-19 knowledge, and preferred news source were associated with being ‘very worried’ versus ‘not at all’ or ‘somewhat’ worried about contracting COVID-19. Survey data were collected in July–August 2020 from N = 547 New York State (NYS) and N = 504 national Amazon MTurk workers. Respondents who endorsed COVID-19 stigmatizing restrictions (NYS OR 1.96; 95% CI 1.31, 2.92; national OR 1.80; 95% CI 1.06, 3.08) and consumed commercial news (NYS OR 1.89; 95% CI 1.21, 2.96; national OR 1.93; 95% CI 1.24, 3.00) were more likely to be very worried. National respondents who consumed The New York Times (OR 1.52; 95% CI 1.00, 2.29) were more likely to be very worried, while those with little knowledge (OR 0.24; 95% CI 0.13, 0.43) were less likely to be very worried. NYS (OR 2.66; 95% CI 1.77, 4.00) and national (OR 3.17; 95% CI 1.95, 5.16) respondents with probable depression were also more likely to be very worried. These characteristics can help identify those requiring intervention to maximize perceived threat to COVID-19 and encourage uptake of protective behaviors while protecting psychological wellbeing.
Facilitating engagement of persons with opioid use disorder in treatment for hepatitis C virus infection via telemedicine: Stories of onsite case managersTalal, A. H., Jaanimägi, U., Davis, K., Bailey, J., Bauer, B. M., Dharia, A., George, S., McLeod, A., Morton, K., Nugent, A., Zeremski, M., Dinani, A., Des Jarlais, D. C., Perumalswami, P. V., Tobin, J. N., & Dickerson, S. S.
Journal titleJournal of Substance Abuse Treatment
Volume127AbstractAlthough hepatitis C virus (HCV) infection has high prevalence and incidence in persons with opioid use disorder (PWOUD), their engagement in HCV care has been limited due to a variety of factors. In an ongoing multisite study at 12 opioid treatment programs (OTPs) throughout New York State (NYS), we have been evaluating telemedicine accompanied by onsite administration of direct acting antiviral (DAA) medications compared with usual care including offsite referral to a liver specialist for HCV management. Each site has a case manager (CM) who is responsible for all study-related activities including participant recruitment, facilitating telemedicine interactions, retention in care, and data collection. Our overall objective is to analyze CM experiences of clients' stories and events to understand how the telemedicine model facilitates HCV treatment. Hermeneutic phenomenology was used to interpret and to explicate common meanings and shared practices of the phenomena of case management, and a focus group with CMs was conducted to reinforce and expand on key themes identified from the CMs' stories. We identified three themes: (1) building trust, (2) identification of multiple competing priorities, and (3) development of personalized care approaches. Our results illustrate that trust is a fundamental pillar on which the telemedicine system can be based. Participants' experiences at the OTP can reinforce trust. Understanding the specific competing priorities and routinizing dedicated personalized approaches to overcome them are key to increasing participation in HCV care among PWOUD.
Is the severity of the Great Recession's aftershocks correlated with changes in access to the combined prevention environment among people who inject drugs?Wise, A., Kianian, B., Chang, H. H., Linton, S., Wolfe, M. E., Smith, J., Tempalski, B., Jarlais, D. D., Ross, Z., Semaan, S., Wejnert, C., Broz, D., & Cooper, H. L.
Journal titleInternational Journal of Drug Policy
Volume95AbstractBackground: The 2008 Recession was a global event that led to funding cuts for programs and services in the United States; though this recession officially ended in 2009, its aftershocks continued through 2012. We evaluated the relationship between the severity of the Great Recession's aftermath and spatial access to combined prevention services (i.e. HIV testing, syringe service programs, substance use disorder treatment program) for people who inject drugs (PWID) living in 19 metropolitan statistical areas (MSAs) in the United States. Methods: The unit of analysis was the ZIP code; we sampled ZIP codes in these 19 MSAs where ≥1 PWID lived in 2009 and 2012, according to the CDC's National HIV Behavioral Surveillance. We used administrative data to describe the combined prevention environment (i.e., spatial access to HIV testing) for each ZIP code, and measured the severity of the recession's aftermath in each ZIP code, and in the counties and MSAs where these ZIP codes were located. Multilevel modeling estimated associations between changes in the aftermath of the Great Recession and ZIP code-level changes in spatial access to combined prevention services from 2009 to 2012. Results: 675 ZIP codes located in 36 counties and 19 MSAs were included in this analysis. From 2009 to 2012, 21% of ZIP code areas lost access to combined prevention services and 14% gained access. ZIP codes with higher poverty rates relative to their respective MSAs were less likely to lose access (aOR: 0.91; 95% CI: 0.88, 0.95) and more likely to gain access (aOR: 1.05; 95% CI: 1.01, 1.09); there is some evidence to suggest the former association was attenuated for ZIP codes with higher percentages of non-Hispanic white residents. Conclusion: Combined prevention services for PWID living in these 675 ZIP codes demonstrated resilience in the aftermath of the Great Recession. Future research should explore whether community-based and federal HIV prevention initiatives contributed to this resilience, particularly in areas with higher concentrations of people of color.
Is your syringe services program cost-saving to society? A methodological case studyDes Jarlais, D. C., Feelemyer, J., McKnight, C., Knudtson, K., & Glick, S. N.
Journal titleHarm Reduction Journal
Issue1AbstractBackground: While there is a general acceptance among public health officials and policy-makers that syringe services programs can be effective in reducing HIV transmission among persons who inject drugs, local syringe services programs are often asked to provide economic justifications for their activities. A cost-effectiveness study, estimating the cost of preventing one HIV infection, would be the preferred methods for addressing this economic question, but few local syringe services programs have the needed data, staff and epidemiologic modeling resources needed for a cost–effectiveness study. We present a method for estimating a threshold value for the number of HIV infections prevented above which the program will be cost-saving to society. An intervention is considered “cost-saving” when it leads to a desirable health outcome a lower cost than the alternative. Methods: The research literature on the effectiveness of syringe services programs in controlling HIV transmission among persons who inject drugs and guidelines for syringe services program that are “functioning very well” were used to estimate the cost-saving threshold at which a syringe services program becomes cost-saving through preventing HIV infections versus lifetime treatment of HIV. Three steps are involved: (1) determining if HIV transmission in the local persons who inject drugs (PWID) population is being controlled, (2) determining if the local syringe services program is functioning very well, and then (3) dividing the annual budget of the syringe services program by the lifetime cost of treating a single HIV infection. Results: A syringe services program in an area with controlled HIV transmission (with HIV incidence of 1/100 person-years or less), functioning very well (with high syringe coverage, linkages to other services, and monitoring the local drug use situation), and an annual budget of $500,000 would need to prevent only 3 new HIV infections per year to be cost-saving. Conclusions: Given the high costs of treating HIV infections, syringe services programs that are operating according to very good practices (“functioning very well”) and in communities in which HIV transmission is being controlled among persons who inject drugs, will almost certainly be cost-saving to society.
Mitochondrial genotoxicity of hepatitis c treatment among people who inject drugsDurand, M., Nagot, N., Nhu, Q. B. T., Vallo, R., Thuy, L. L. T., Duong, H. T., Thanh, B. N., Rapoud, D., Quillet, C., Tran, H. T., Michel, L., Tuyet, T. N. T., Hai, O. K. T., Hai, V. V., Feelemyer, J., Perre, P. V., Jarlais, D. D., Minh, K. P., Laureillard, D., & Molès, J. P.
Journal titleJournal of Clinical Medicine
Issue21AbstractAntiviral nucleoside analogues (ANA) are newly used therapeutics acting against the hepatitis C virus (HCV). This class of drug is well known to exhibit toxicity on mitochondrial DNA (mtDNA). People who inject drugs (PWID) are particularly affected by HCV infection and cumu-lated mitotoxic drug exposure from HIV treatments (antiretrovirals, ARV) and other illicit drugs. This study aims to explore the impact of direct-acting antiviral (DAA) treatments on mtDNA among PWID. A total of 470 actively injecting heroin users were included. We used quantitative PCR on whole blood to determine the mitochondrial copy number per cell (MCN) and the proportion of mitochondrial DNA deletion (MDD). These parameters were assessed before and after DAA treat-ment. MDD was significantly increased after HCV treatment, while MCN did not differ. MDD was even greater when subjects were cotreated with ARV. In multivariate analysis, we identified that poly-exposure to DAA and daily heroin injection or regular consumption of methamphetamines were positively associated with high MCN loss while DAA and ARV treatments or methadone use were identified as risk factors for having mtDNA deletion. These observations deserve attention since they were previously associated with premature cell ageing or cell transformation and there-fore call for a long-term follow-up.
Place-Based Correlates of Exchange Sex Among People Who Inject Drugs in 19 U.S. Metropolitan Areas, 2012Wise, A., Kianian, B., Chang, H., Linton, S., Wolfe, M. E., Smith, J., Tempalski, B., Des Jarlais, D., Ross, Z., Semaan, S., Wejnert, C., Broz, D., & Cooper, H.
Journal titleArchives of Sexual Behavior
Page(s)2897-2909AbstractThis study examined overall and gender-specific associations between place-based characteristics and opposite-sex exchange sex among people who inject drugs (PWID) in the U.S. PWID were recruited from 19 metropolitan statistical areas (MSAs) for the Centers for Disease Control and Prevention’s 2012 National HIV Behavioral Surveillance. Administrative data were used to describe the economic, social, and political features of the ZIP codes, MSAs, counties, and states where PWID lived. Multilevel modeling estimated associations of place characteristics and exchange sex. We found that 52% of women and 23% of men reported past-year opposite-sex exchange sex (N = 7599). Female PWID living in states with stronger policies supporting working caregivers had lower odds of exchange sex (aOR = 0.80; 95% CI 0.69, 0.94). PWID living in ZIP codes with greater economic deprivation had higher odds of exchange sex (aOR = 1.10; 95% CI 1.03, 1.17). We found that a high percentage of male PWID exchanged sex with women; determinants and risks of this group merit exploration. If future research establishes that the relationships identified here are causal, interventions to reduce exchange sex among PWID should include policies supporting working caregivers and reducing poverty rates.
Provider Perspectives on Barriers to Routine HIV Testing of Adolescent and Young Adult Patients in Emergency Department Settings
Rapid point-of-care (POC) testing for Hepatitis C antibodies in a very high prevalence setting: persons injecting drugs in Tallinn, Estonia
Sociodemographic and Behavioral Factors Associated With COVID-19 Stigmatizing Attitudes in the U.S.Grivel, M. M., Lieff, S. A., Meltzer, G. Y., Chang, V. W., Yang, L. H., & Jarlais, D. C.
Journal titleStigma and Health
Page(s)371-379AbstractTo control the spread of coronavirus disease (COVID-19) and prevent further verbal and physical discrimination against individuals affected by, or perceived to be responsible for, COVID-19, proactive efforts must be made to ameliorate stigmatizing attitudes. This study seeks to examine whether key sociobehavioral factors including news consumption and contact with Chinese individuals are associated with COVID-19 stigma as a first step to informing stigma interventions. Surveys were administered to N = 498non-representative national respondents in August 2020 via Amazon’s Mechanical Turk and includedassessments of COVID-19 stigma, worry, knowledge, contact with COVID-19 and Chinese individuals, and preferred news source. Prevalence of stigmatizing beliefs was 65.46%. Odds of endorsing stigma were higher among males (OR = 1.77, 95% CI [1.07–2.93]) vs. females, Non-Hispanic Black (OR = 3.12, 95% CI [1.42–6.86]) and Hispanic (OR = 4.77, 95% CI [2.32–9.78]) vs. Non-Hispanic White individuals, and individuals with college degrees (OR = 3.41, 95% CI [1.94–5.99]) and more than college degrees (OR = 3.04, 95% CI [1.34–6.89]) vs. those with less than college degrees. Consumers (vs. non-consumers) of Fox News (OR = 4.43, 95% CI [2.52–7.80]) and social media (OR = 2.48, 95% CI [1.46–4.20]) had higher odds of endorsing stigma. Contact with Chinese individuals (OR = 0.50, 95% CI [0.25–1.00]) wasassociated with lower odds of endorsing stigma. These findings suggest that individuals of Non-HispanicBlack or Hispanic race/ethnic background, consumers of Fox News and social media, men, and individuals with college degrees or higher are groups that should be prioritized for anti-stigma intervention. Our finding that social contact with Chinese individuals is associated with decreased odds of stigma that provides initial support for the implementation of interventions based on contact with individuals of Chinese descent
Syringe Services Programs’ Role in Ending the HIV Epidemic in the U.S.: Why We Cannot Do It Without ThemBroz, D., Carnes, N., Chapin-Bardales, J., Des Jarlais, D. C., Handanagic, S., Jones, C. M., McClung, R. P., & Asher, A. K.
Journal titleAmerican journal of preventive medicine
Page(s)S118-S129AbstractDiagnoses of HIV among people who inject drugs have increased in the U.S. during 2014–2018 for the first time in 2 decades, and multiple HIV outbreaks have been detected among people who inject drugs since 2015. These epidemiologic trends pose a significant concern for achieving goals of the federal initiative for Ending the HIV Epidemic in the U.S. Syringe services programs are cost effective, safe, and highly effective in reducing HIV transmission and are an essential component of a comprehensive, integrated approach to addressing these concerns. Yet, geographic coverage of these programs remains limited in the U.S., and many jurisdictions continue to have laws and policies that limit or disallow syringe services programs. An in-depth literature review was conducted on the role of syringe services programs in the Ending the HIV Epidemic initiative. Empirical and model-based evidence consistently shows that syringe services programs have the highest impact in HIV prevention when combined with access to medications for substance use disorder and antiretroviral therapy. Their effectiveness is further maximized when they provide services without restrictions and include proven and innovative strategies to expand access to harm-reduction and clinical services (e.g., peer outreach, telehealth). Increasing geographic and service coverage of syringe services programs requires strong and sustainable policy, funding, and community support and will need to address new challenges related to the COVID-19 pandemic. Syringe services programs have a key role in all 4 Ending the HIV Epidemic initiative strategies—Prevent, Diagnose, Treat, and Respond—and thus are instrumental to its success in preventing disease and saving lives.
The methamphetamine epidemic among persons who inject heroin in Hai Phong, VietnamFailed generating bibliography.Abstract
Journal titleJournal of Substance Abuse Treatment
Volume126AbstractAims: To describe the current methamphetamine (MA) use epidemic among persons who inject heroin (PWID) in Hai Phong, Vietnam, and consider possibilities for mitigating adverse effects of methamphetamine use. Methods: This study conducted surveys of PWID in 2016, 2017, and 2018 (N = 1383, 1451, and 1445, respectively). Trained interviewers administered structured interviews covering drug use histories, current drug use, and related risk behaviors. The study used urinalysis to confirm current drug use, and conducted HIV and HCV testing. Results: Participants were predominantly male (95%), mean age of 40, and all reported injecting heroin. Respondents' reports of initiating MA use were rare up through early 2000s but increased exponentially through the mid-2010s. MA use was predominantly “smoking,” heating the drug and inhaling the vapor using a pipe; injecting MA was rare. Current (past 30 day) MA use appears to have plateaued in 2016–2018 with 53–58% of participants reporting no use in the last 30 days, 37–41% reporting low to moderate use (1 to 19 days in last 30 days), and 5–7% reporting very frequent use (20 or more days in last 30 days). This plateau reflects a rough balance between new users and individuals ceasing use. Conclusions: MA use has become a substantial public health problem among PWID in Hai Phong. Initiation into MA use rose exponentially from 2005 to about 2015. Use of MA will likely continue for a substantial number of PWID. Currently, no medication is approved for treating MA disorders in Vietnam. Current psychosocial treatment requires highly trained counselors and months of treatment, so that psychosocial treatment for all PWID with MA disorders is likely beyond the resources available in a middle-income country such as Vietnam. Harm reduction programs implemented by community-based organization staff may provide a way to rapidly address aspects of the current MA epidemic. Such programs could emphasize social support for reducing use where possible and for avoiding escalation of use among persons continuing to use.
Using large-scale respondent driven sampling to monitor the end of an HIV epidemic among persons who inject drugs in Hai Phong, Viet NamDes Jarlais, D. C., Arasteh, K., Huong, D. T., Oanh, K. T. H., Feelemyer, J. P., Khue, P. M., Giang, H. T., Thanh, N. T. T., Vinh, V. H., Le, S. M., Vallo, R., Quillet, C., Rapoud, D., Michel, L., Laureillard, D., Moles, J. P., & Nagot, N.
Journal titlePloS one
Issue11AbstractAIMS: To describe the use of large-scale respondent driven sampling (RDS) surveys to demonstrate the "end of an HIV epidemic" (HIV incidence < 0.5/100 person-years) among persons who inject drugs (PWID) in a middle-income country. Large sample sizes are needed to convincingly demonstrate very low incidence rates.METHODS: 4 large surveys (Ns approximately 1500 each) were conducted among PWID in Hai Phong, Vietnam in 2016-2019. Respondent driven sampling (RDS) with a modification to add snowball sampling was used for recruiting participants. HIV incidence was measured through recency testing, repeat participants across multiple surveys and in a cohort study of PWID recruited from the surveys. RDS analytics (time to equilibria and homophilies for major variables) were used to assess similarities/differences in RDS only versus RDS plus snowball recruiting. Characteristics were compared among respondents recruited through standard RDS recruitment versus through snowball sampling. An overall assessment of the robustness of RDS to modification was made when adding a snowball sampling recruitment.RESULTS: RDS recruiting was very efficient in the first 5 weeks of each survey with approximately 180 respondents recruited per week. Recruiting then slowed considerably, and snowball sampling (permitting an individual respondent to recruit large numbers of new respondents) was added to the existing RDS recruiting. This led to recruiting within 13-14 weeks of 1383, 1451, 1444 and 1268 respondents, close to the target of 1500 respondents/survey. Comparisons of participants recruited through standard RDS method and respondents recruited through snowball methods showed very few significant differences. RDS analytics (quickly reaching equilibria, low homophilies) were favorable for both RDS recruited and total numbers of participants in each survey. DRug use and Infections in ViEtnam (DRIVE) methods have now been officially adopted in other provinces.CONCLUSIONS: RDS appears to be quite robust with respect to adding a modest number of participants recruited through snowball sampling. Large sample sizes can provide compelling evidence for "ending an HIV epidemic" to policy makers in a PWID population in a middle income country setting.
Associations between methamphetamine use and lack of viral suppression among a cohort of HIV-positive persons who inject drugs in Hai Phong, Vietnam
Cost-effectiveness of direct antiviral agents for hepatitis c virus infection and a combined intervention of syringe access and medication-assisted therapy for opioid use disorders in an injection drug use populationStevens, E. R., Nucifora, K. A., Hagan, H., Jordan, A. E., Uyei, J., Khan, B., Dombrowski, K., Des Jarlais, D., & Scott Braithwaite, R.
Journal titleClinical Infectious Diseases
Page(s)2652-2662AbstractBackground: There are too many plausible permutations and scale-up scenarios of combination hepatitis C virus (HCV) interventions for exhaustive testing in experimental trials. Therefore, we used a computer simulation to project the health and economic impacts of alternative combination intervention scenarios for people who inject drugs (PWID), focusing on direct antiviral agents (DAA) and medication-assisted treatment combined with syringe access programs (MAT+). Methods. We performed an allocative efficiency study, using a mathematical model to simulate the progression of HCV in PWID and its related consequences. We combined 2 previously validated simulations to estimate the cost-effectiveness of intervention strategies that included a range of coverage levels. Analyses were performed from a health-sector and societal perspective, with a 15-year time horizon and a discount rate of 3%. Results. From a health-sector perspective (excluding criminal justice system-related costs), 4 potential strategies fell on the cost-efficiency frontier. At 20% coverage, DAAs had an incremental cost-effectiveness ratio (ICER) of $27 251/quality-adjusted life-year (QALY). Combinations of DAA at 20% with MAT+ at 20%, 40%, and 80% coverage had ICERs of $165 985/QALY, $325 860/ QALY, and $399 189/QALY, respectively. When analyzed from a societal perspective (including criminal justice system-related costs), DAA at 20% with MAT+ at 80% was the most effective intervention and was cost saving. While DAA at 20% with MAT+ at 80% was more expensive (eg, less cost saving) than MAT+ at 80% alone without DAA, it offered a favorable value compared to MAT+ at 80% alone ($23 932/QALY). Conclusions. When considering health-sector costs alone, DAA alone was the most cost-effective intervention. However, with criminal justice system-related costs, DAA and MAT+ implemented together became the most cost-effective intervention.