Don Des Jarlais

Don Des Jarlais
Don Des Jarlais

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

A cohort study revealed high mortality among people who inject drugs in Hai Phong, Vietnam

A Multistage Process Model of How a Person Who Currently Injects Drugs Comes to Assist Persons Who Do not Inject with Their 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 drugs

Automated Substance Use/Sexual Risk Reporting and HIV Test Acceptance Among Emergency Department Patients Aged 13–24 Years

Aronson, I. D., Zhang, J., Rajan, S., Marsch, L. A., Bugaighis, M., Ibitoye, M. O., Chernick, L. S., & Des Jarlais, D. C.

Publication year

2021

Journal title

AIDS and Behavior
Abstract
Abstract
Despite 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.

Behavioral correlates of COVID-19 worry: Stigma, knowledge, and news source

Meltzer, G. Y., Chang, V. W., Lieff, S. A., Grivel, M. M., Yang, L. H., & Des Jarlais, D. C.

Publication year

2021

Journal title

International journal of environmental research and public health

Volume

18

Issue

21
Abstract
Abstract
Non-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.

Development and assessment of a community-based screening tool for mental health disorders among people who inject drugs

Durable Viral Suppression Among People with HIV and Problem Substance Use in the Era of Universal Antiretroviral Treatment

Paschen-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.

Publication year

2021

Journal title

AIDS and Behavior
Abstract
Abstract
This 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.

Facilitating engagement of persons with opioid use disorder in treatment for hepatitis C virus infection via telemedicine: Stories of onsite case managers

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.

Publication year

2021

Journal title

International Journal of Drug Policy

Volume

95
Abstract
Abstract
Background: 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.

Mitochondrial genotoxicity of hepatitis c treatment among people who inject drugs

Durand, 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.

Publication year

2021

Journal title

Journal of Clinical Medicine

Volume

10

Issue

21
Abstract
Abstract
Antiviral 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, 2012

Program Adaptations to Provide Harm Reduction Services During the COVID-19 Pandemic: A Qualitative Study of Syringe Services Programs in the U.S.

Rapid point-of-care (POC) testing for Hepatitis C antibodies in a very high prevalence setting: persons injecting drugs in Tallinn, Estonia

Uusküla, A., Talu, A., Rannap, J., Barnes, D. M., & Jarlais, D. D.

Publication year

2021

Journal title

Harm Reduction Journal

Volume

18

Issue

1
Abstract
Abstract
Background: Between December 2018 and January of 2019, we evaluated the accuracy of the point-of-care Hepatitis C (HCV) antibody test (POC; OraQuick HCV) used at a community-based needle and syringe exchange program serving persons who inject drugs in Tallinn, Estonia. Methods: We compared the results of screening for HCV antibodies by OraQuick (oral swab) and enzyme immunoassay (EIA; blood draw) and assessed test results implications in a high prevalence setting. Findings Of the 100 participants, 88 (88%) had reactive POC test results, and 93 were HCV antibody positive on EIA testing. Sensitivity, specificity and negative predictive value (NPV) for the POC assay with EIA as the relevant reference test were as follows: 94.6% (95% CI 90.0–99.2%), 100% and 58.3% (95% CI 30.4–86.2%). Of the 12 testing, HCV-negative with the POC only 7 (58.3%) were true negatives. Conclusions: Oral swab rapid testing HCV screening in this nonclinical setting was sensitive and specific but had unacceptably low NPV. In high prevalence settings, POC tests with high sensitivity and that directly measure HCV RNA may be warranted.

Sociodemographic and Behavioral Factors Associated With COVID-19 Stigmatizing Attitudes in the U.S.

Syringe Services Programs’ Role in Ending the HIV Epidemic in the U.S.: Why We Cannot Do It Without Them

Broz, D., Carnes, N., Chapin-Bardales, J., Des Jarlais, D. C., Handanagic, S., Jones, C. M., McClung, R. P., & Asher, A. K.

Publication year

2021

Journal title

American journal of preventive medicine

Volume

61

Issue

5

Page(s)

S118-S129
Abstract
Abstract
Diagnoses 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, Vietnam

Thick trust, thin trust, social capital, and health outcomes among trans women of color in New York City

Hwahng, S. J., Allen, B., Zadoretzky, C., Barber Doucet, H., McKnight, C., & Des Jarlais, D.

Publication year

2021

Journal title

International Journal of Transgender Health
Abstract
Abstract
Introduction: Many trans women of color communities experience high HIV seroprevalence, extreme poverty, high rates of victimization and substance use, and poor mental health. Greater knowledge of trans women of color social capital may contribute toward more effective services for this marginalized population. Methods: These data come from a mixed-methods study that examined trans/gender-variant people of color who attended transgender support groups at harm reduction programs in NYC. The study was conducted from 2011 to 12, total N = 34. The qualitative portion was derived from six focus group interviews. Results: Two support groups stood out as exhibiting very strong alternative kinship structures. One group was comprised of immigrant trans Latinas, and the other group were trans women of African descent living with HIV. Both groups demonstrated ample cultivation of “trust capital” in the form of “thick trust” (bonding capital) and “thin trust” (bridging/linking capital) both inside and outside/beyond the support groups. Thick trust included the cultivation of intimacy, support in primary romantic relationships, and community leadership. Thin trust included networking with a variety of organizations, increased educational opportunities, and cultural production. Discussion: Participants “opened up to social capital” through the process of trusting as a series of (1) risks; (2) vulnerabilities; and (3) reciprocities. A solid foundation of thick trust resulted in a social, psychological, and emotional “base.” Upon this foundation, thin trust was operationalized resulting in positive material, economic, and quality-of-life outcomes, leading to an expanded space of capabilities.

Using large-scale respondent driven sampling to monitor the end of an HIV epidemic among persons who inject drugs in Hai Phong, Viet Nam

Associations between methamphetamine use and lack of viral suppression among a cohort of HIV-positive persons who inject drugs in Hai Phong, Vietnam

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Publication year

2020

Journal title

AIDS

Volume

34

Issue

13

Page(s)

1875-1882
Abstract
Abstract
Objective: We assessed the association between methamphetamine use and lack of viral suppression among a cohort of HIV-seropositive persons who inject drugs (PWID) in Hai Phong, Vietnam. Design: Cohort study with random effects logit modeling and mediation analysis for antiretroviral therapy (ART) adherence. Methods: PWID were recruited from October 2016 to October 2017; HIV-seropositive PWID were enrolled in a cohort to assess HIV viral loads, changes in drug use, risk behaviors, and ART adherence during 24-month follow-up. Methamphetamine use in last 30 days was divided into three categories: 0 days (no use), 1 – 19 days (intermediate), and 20 or more days (heavy). Bivariate and a multivariable random effects logit models were used to assess the relationship between methamphetamine use and not being virally suppressed. We also assessed self-reported ART adherence as a mediating factor. Results: A total of 645 HIV-seropositive PWID were included at baseline; 95% male, average age 40 (SD ¼ 6.4). At baseline, methamphetamine use in last 30 days was 64% no use, 32% intermediate use, 4% heavy use. Approximately 74% of PWID reported high/complete adherence; 76% were at viral suppression. In random effects analysis, recent methamphetamine use was associated with not being virally suppressed during follow-up (adjusted odds ratio: 1.84, 95% confidence interval: 1.06, 3.17); the effect was not explained by a mediating effect of self-reported adherence to ART. Conclusion: Recent methamphetamine use is associated with not being virally suppressed among PWID. The results of this study indicate the need for targeted interventions for methamphetamine use with special focus on those with HIV infection.

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 population

Stevens, E. R., Nucifora, K. A., Hagan, H., Jordan, A. E., Uyei, J., Khan, B., Dombrowski, K., Des Jarlais, D., & Scott Braithwaite, R.

Publication year

2020

Journal title

Clinical Infectious Diseases

Volume

70

Issue

12

Page(s)

2652-2662
Abstract
Abstract
Background: 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.

Daily heroin injection and psychiatric disorders: A cross-sectional survey among People Who Inject Drugs (PWID) in Haiphong, Vietnam

DSM-5 substance use disorder symptom clusters and HIV antiretroviral therapy (ART) adherence

Paschen-Wolff, M. M., Campbell, A. N., Tross, S., Choo, T. H., Pavlicova, M., & Jarlais, D. D.

Publication year

2020

Journal title

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

Volume

32

Issue

5

Page(s)

645-650
Abstract
Abstract
This study examines self-reported 30-day antiretroviral therapy (ART) adherence among 101 people living with HIV and substance use disorders (SUD) in New York City in terms of Diagnostic and Statistical Manual–5th Edition (DSM-5) SUD symptom clusters: impaired control, social impairment, risky use and pharmacological criteria. Overall, 60.4% met DSM-5 criteria for stimulant, 55.5% for alcohol, 34.7% for cannabis and 25.7% for opioid SUD. Of the 76 participants with a current ART prescription, 75.3% reported at least 90% 30-day adherence. Participants with vs. without alcohol SUD were significantly less likely to report ART adherence (64.3% vs. 88.2%, p =.017). Endorsement of social impairment significantly differed among adherent vs. non-adherent participants with alcohol SUDs (74.1% vs. 100%, p =.038) and with opioid SUDs (94.1% vs. 50.0%, p =.040). Understanding specific SUD symptom clusters may assist providers and patients in developing strategies to improve ART adherence.

Ending an HIV epidemic among persons who inject drugs in a middle-income country: Extremely low HIV incidence among persons who inject drugs in Hai Phong, Viet Nam

Expansion of syringe service programs in the United States, 2015-2018

Hepatitis C incidence and prevalence among Puerto Rican people who use drugs in New York City

Arasteh, K., Des Jarlais, D. C., Feelemyer, J., & McKnight, C.

Publication year

2020

Journal title

Global Public Health

Volume

15

Issue

12

Page(s)

1789-1799
Abstract
Abstract
Background: Hepatitis C virus (HCV) infection is associated with substantial morbidity and mortality among people who use drugs (PWUD). Health disparities related to race/ethnicity and immigration status also increase the risk of HCV infection and decrease the probability of linkage to care. Effective, curative treatment is now available for HCV infection and, alongside prevention, may eliminate HCV epidemics. Methods: We examined HCV incidence, prevalence and associated risk factors among 5459 Puerto Rican (both PR-born and U.S.-born) and non-Puerto Rican (only U.S.-born) entrants to Mount Sinai Beth Israel drug treatment programs in New York City, from August 2005 to January 2018, to assess the need for HCV screening, prevention and treatment in this population. Results: HCV incidence and prevalence among Puerto Rican PWUD was significantly greater than the non-Puerto Ricans PWUD. Among people who inject drugs (PWID), there was no difference in injection risk behaviours by ethnicity/birth place. Conclusions: Findings suggest HCV treatment is a necessary component of a strategy to eliminate HCV epidemics among PWUD. Findings also underline the interconnectedness of epidemics across regions, such that to eliminate the HCV epidemic in one location may depend on eliminating the HCV epidemics in other locations.

Contact

ddj2@nyu.edu 708 Broadway 7FL New York, NY, 10003