Don Des Jarlais
Don Des Jarlais
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Professor of Epidemiology
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Professional overview
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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.
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Education
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BA, Behavioral Science, Rice University, Houston, TXPhD, Social Psychology, University of Michigan, Ann Arbor, MI
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Areas of research and study
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EpidemiologyHIV/AIDSPsychology
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Publications
Publications
Drug Misuse as an Epidemic
AbstractUusküla, A., Feelemyer, J., & Des Jarlais, D. C. (n.d.). In Handbook of Substance Misuse and Addictions: A Focus on the Synthetic Opioid Fentanyl (1–).Publication year
2022Page(s)
1921-1939AbstractThe spread of illicitly manufactured fentanyl has the potential to greatly increase fatal overdoses in many places in the world. In 2015, Estonia and the USA ranked first and second, respectively, among the world’s wealthy nations in men’s drug overdose deaths. Evidence from various resources document illicitly produced fentanyl as a major contributor to the Estonian and US overdose death epidemics. The purpose of this chapter is to analyze the dynamics of fentanyl use based on a drug epidemics approach. We contrast the fentanyl epidemic in Estonia to that in the USA and propose applications for other areas. In areas faced with fentanyl epidemics, we prioritize large-scale implementation of naloxone distribution to reduce mortality, syringe service programs to provide for safer injecting, and links to other services (high frequency of fentanyl injection creates a high risk for HIV and HCV transmission). Further, means of identifying and responding to emerging substances should fit the increasingly dynamic illicit drug markets. Addressing illicitly manufactured fentanyl may serve as a public health learning experience for developing early detection and rapid response programs in rapidly changing drug use environments.Durable Viral Suppression Among People with HIV and Problem Substance Use in the Era of Universal Antiretroviral Treatment
AbstractPaschen-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. (n.d.).Publication year
2022Journal title
AIDS and BehaviorVolume
26Issue
2Page(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.Expectations of racial prejudice in AIDS research and prevention programs in the United States
AbstractDes Jarlais, D. C., Casriel, C., Stepherson, B., & Friedman, S. R. (n.d.). In AIDS and Alcohol/Drug Abuse (1–).Publication year
2022Page(s)
1-7AbstractHIV infection and AIDS have occurred at disproportionately higher rates among Black and Hispanic persons in the United States. The HIV epidemic is occurring within an historical context of racial prejudice and inequality within the society as a whole, and of poor health care for minority communities. We report instances of expectations of racial prejudice that affected three different AIDS research/prevention activities. Failure to anticipate and appropriately respond to these expectations of racial prejudice may substantially interfere with AIDS efforts and appear to confirm the expectations. Even with the best anticipation and responses, there will be many instances in which the problem cannot be satisfactorily resolved. The association of AIDS with minority status has the potential to reinforce stigmatization of minority communities. Prevention and research activities will often be caught in lose-lose situations of either "unfairly singing out" minorities or of ignoring the problems of minority communities.Harm reduction and health services provided by syringe services programs in 2019 and subsequent impact of COVID-19 on services in 2020
AbstractBehrends, 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. (n.d.).Publication year
2022Journal title
Drug and alcohol dependenceVolume
232AbstractObjectives: 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 investigation
AbstractNguyen, 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. (n.d.).Publication year
2022Journal title
Harm Reduction JournalVolume
19Issue
1AbstractIntroduction: 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.Long-Term Persistence of Mitochondrial DNA Instability among HCV-Cured People Who Inject Drugs
AbstractDurand, M., Nagot, N., Nhu, Q. B. T., Vizeneux, A., Thuy, L. L. T., Duong, H. T., Thanh, B. N., Rapoud, D., Vallo, R., Quillet, C., Tran, H. T., Michel, L., Tuyet, T. N. T., Hai, O. K. T., Hai, V. V., Feelemyer, J., Vande Perre, P., Des Jarlais, D., Minh, K. P., … Molès, J. P. (n.d.).Publication year
2022Journal title
BiomedicinesVolume
10Issue
10AbstractPeople who inject drugs (PWID) are a population exposed to many genotoxicants and with a high prevalence of HCV infection. Direct-acting antiviral (DAA) regimens are now widely used to treat chronic HCV infection. Although side effects to treatment are currently rare, the long-term effects such as suspicions of de novo hepatocellular carcinoma (HCC) occurrence or HCC recurrence and cardiac defects are still up for debate. Given the structure of DAAs, the molecules have a potential mitochondrial DNA (mtDNA) genotoxicity. We have previously reported acute mtDNA toxicity of three DAA regimens among PWID with a strong impact on the rate of mtDNA deletion, less on the quantity of mtDNA copy per cell at sustained viral response at 12 weeks (SVR12). Herein, we report the mtDNA parameters nine months after drug discontinuation. We observed that the percentage of the deleted mtDNA genome increased over time. No exposure to any other genotoxicants during this period was associated with a high deletion percentage, suggesting that the replicative advantage of the deleted molecules outweighed their elimination processes. Such observation calls for longer-term follow-up and may contribute to the molecular basis of subclinical side effects of DAA treatments.Mental Disorders Are Associated With Leukocytes Telomere Shortening Among People Who Inject Drugs
AbstractDurand, M., Nagot, N., Michel, L., Le, S. M., Duong, H. T., Vallo, R., Vizeneux, A., Rapoud, D., Giang, H. T., Quillet, C., Thanh, N. T. T., Hai Oanh, K. T., Vinh, V. H., Feelemyer, J., Vande Perre, P., Minh, K. P., Laureillard, D., Des Jarlais, D., & Molès, J. P. (n.d.).Publication year
2022Journal title
Frontiers in PsychiatryVolume
13AbstractPremature biological aging, assessed by shorter telomere length (TL) and mitochondrial DNA (mtDNA) alterations, has been reported among people with major depressive disorders or psychotic disorders. However, these markers have never been assessed together among people who inject drugs (PWIDs), although mental disorders are highly prevalent in this population, which, in addition, is subject to other aggravating exposures. Diagnosis of mental disorders was performed by a psychiatrist using the Mini International Neuropsychiatric Interview test among active PWIDs in Haiphong, Vietnam. mtDNA copy number (MCN), mtDNA deletion, and TL were assessed by quantitative PCR and compared to those without any mental disorder. We next performed a multivariate analysis to identify risk factors associated with being diagnosed with a major depressive episode (MDE) or a psychotic syndrome (PS). In total, 130 and 136 PWIDs with and without psychiatric conditions were analyzed. Among PWIDs with mental disorders, 110 and 74 were diagnosed with MDE and PS, respectively. TL attrition was significantly associated with hepatitis C virus-infected PWIDs with MDE or PS (adjusted odds ratio [OR]: 0.53 [0.36; 0.80] and 0.59 [0.39; 0.88], respectively). TL attrition was even stronger when PWIDs cumulated at least two episodes of major depressive disorders. On the other hand, no difference was observed in mtDNA alterations between groups. The telomeric age difference with drug users without a diagnosis of psychiatric condition was estimated during 4.2–12.8 years according to the number of MDEs, making this group more prone to age-related diseases.Modeling HIV transmission among persons who inject drugs (PWID) at the “End of the HIV Epidemic” and during the COVID-19 pandemic
AbstractJarlais, D. D., Bobashev, G., Feelemyer, J., & McKnight, C. (n.d.).Publication year
2022Journal title
Drug and alcohol dependenceVolume
238AbstractBackground: We explore injecting risk and HIV incidence among PWID in New York City (NYC), from 2012 to 2019, when incidence was extremely low, <0.1/100 person-years at risk, and during disruption of prevention services due to the COVID-19 pandemic. Methods: We developed an Agent-Based model (ABM) to simulate sharing injecting equipment and measure HIV incidence in NYC. The model was adapted from a previous ABM model developed to compare HIV transmission with “high” versus “low” dead space syringes. Data for applying the model to NYC during the period of very low HIV incidence was taken from the “Risk Factors” study, a long-running study of participants entering substance use treatment in NYC. Injecting risk behavior had not been eliminated in this population, with approximately 15 % reported recent syringe sharing. Data for possible transmission during COVID-19 disruption was taken from previous HIV outbreaks and early studies of the pandemic in NYC. Results: The modeled incidence rates fell within the 95 % confidence bounds of all of the empirically observed incidence rates, without any additional calibration of the model. Potential COVID-19 disruptions increased the probability of an outbreak from 0.03 to 0.25. Conclusions: The primary factors in the very low HIV incidence were the extremely small numbers of PWID likely to transmit HIV and that most sharing occurs within small, relatively stable, mostly seroconcordant groups. Containing an HIV outbreak among PWID during a continuing pandemic would be quite difficult. Pre-pandemic levels of HIV prevention services should be restored as quickly as feasible.Program Adaptations to Provide Harm Reduction Services During the COVID-19 Pandemic: A Qualitative Study of Syringe Services Programs in the U.S.
AbstractFrost, 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. (n.d.).Publication year
2022Journal title
AIDS and BehaviorVolume
26Issue
1Page(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.Recurrent Injecting Drug Use as a Mediator between Psychiatric Disorder and Non-Fatal Overdose
AbstractBarnes, D. M., Xu, S., Cleland, C. M., McKnight, C., & Des Jarlais, D. (n.d.).Publication year
2022Journal title
Substance Use and MisuseVolume
57Issue
8Page(s)
1248-1256AbstractBackground: Unintentional drug overdose has increased markedly in the United States. Studies document an association between psychiatric disorder and unintentional overdose; we extend this research through a preliminary test of a causal model of recurrent injection drug use mediating this relationship. Methods: In a cross-sectional study of 241 adults in New York City with a possible current substance use disorder, we conducted conventional and Imai’s mediation analyses to examine if psychiatric disorder is associated with increased prevalence of ever overdosing and if recurrent injection drug use mediates this association. Our cross-sectional data permit the first step of assessing causal models: testing if statistical associations are consistent with the model. Results: Fifty-eight percent of the sample endorsed previous psychiatric disorder diagnosis and 35.7% reported ever overdosing. Imai’s mediation analysis showed that, adjusting for covariates, the total association between psychiatric diagnosis and ever overdosing (adjusted prevalence difference [aPD] = 0.16, 95% CI 0.04–0.28) was composed of a direct effect (aPD = 0.09, 95% CI −0.03 − 0.21, p = 0.136) and an indirect effect (aPD = 0.07, 95% CI 0.02–0.13). Recurrent injecting drug use contributed to 42% (ratio of indirect effect to total effect; 95% CI 12 − 100%, p = 0.02) of the association between psychiatric diagnosis and ever overdosing. Conventional mediation analysis produced similar results. Conclusions: Our results provide a warrant for taking the necessary next step for assessing a causal model using longitudinal data, potentially providing a strong rationale for intervening on psychiatric disorders to stem overdose.Responding to a surge in overdose deaths: perspectives from US syringe services programs
AbstractFrost, M. C., Austin, E. J., Corcorran, M. A., Briggs, E. S., Behrends, C. N., Juarez, A. M., Frank, N. D., Healy, E., Prohaska, S. M., LaKosky, P. A., Kapadia, S. N., Perlman, D. C., Schackman, B. R., Des Jarlais, D. C., Williams, E. C., & Glick, S. N. (n.d.).Publication year
2022Journal title
Harm Reduction JournalVolume
19Issue
1AbstractBackground: US overdose deaths have reached a record high. Syringe services programs (SSPs) play a critical role in addressing this crisis by providing multiple services to people who use drugs (PWUD) that help prevent overdose death. This study examined the perspectives of leadership and staff from a geographically diverse sample of US SSPs on factors contributing to the overdose surge, their organization’s response, and ongoing barriers to preventing overdose death. Methods: From 2/11/2021 to 4/23/2021, we conducted semi-structured interviews with leadership and staff from 27 SSPs sampled from the North American Syringe Exchange Network directory. Interviews were transcribed and qualitatively analyzed using a Rapid Assessment Process. Results: Respondents reported that increased intentional and unintentional fentanyl use (both alone and combined with other substances) was a major driver of the overdose surge. They also described how the COVID-19 pandemic increased solitary drug use and led to abrupt increases in use due to life disruptions and worsened mental health among PWUD. In response to this surge, SSPs have increased naloxone distribution, including providing more doses per person and expanding distribution to people using non-opioid drugs. They are also adapting overdose prevention education to increase awareness of fentanyl risks, including for people using non-opioid drugs. Some are distributing fentanyl test strips, though a few respondents expressed doubts about strips’ effectiveness in reducing overdose harms. Some SSPs are expanding education and naloxone training/distribution in the broader community, beyond PWUD and their friends/family. Respondents described several ongoing barriers to preventing overdose death, including not reaching certain groups at risk of overdose (PWUD who do not inject, PWUD experiencing homelessness, and PWUD of color), an inconsistent naloxone supply and lack of access to intranasal naloxone in particular, inadequate funding, underestimates of overdoses, legal/policy barriers, and community stigma. Conclusions: SSPs remain essential in preventing overdose deaths amid record numbers likely driven by increased fentanyl use and COVID-19-related impacts. These findings can inform efforts to support SSPs in this work. In the face of ongoing barriers, support for SSPs—including increased resources, political support, and community partnership—is urgently needed to address the worsening overdose crisis.Thick trust, thin trust, social capital, and health outcomes among trans women of color in New York City
AbstractHwahng, S. J., Allen, B., Zadoretzky, C., Barber Doucet, H., McKnight, C., & Des Jarlais, D. (n.d.).Publication year
2022Journal title
International Journal of Transgender HealthVolume
23Issue
1Page(s)
214-231AbstractIntroduction: 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.“Maintaining HIV and HCV prevention and care for people who inject drugs despite COVID‐19 in Hai Phong, Vietnam”
AbstractGiang, H. T., Duc, N. Q., Molès, J. P., Vinh, V. H., Nagot, N., Thanh, N. T. T., Huong, D. T., Oanh, K. T. H., Khue, P. M., Mai, L. S., Trang, N. T., Ngoc, P. T., Quillet, C., Feelemyer, J., Vallo, R., Michel, L., Jarlais, D. D., Laureillard, D., & Rapoud, D. (n.d.).Publication year
2022Journal title
International Journal of Drug PolicyVolume
110AbstractBackground: After the emergence of COVID-19, a one-month strict lockdown was imposed in April 2020 in Vietnam, followed by lighter social distancing restrictions over the year. We investigated whether those measures affected people who inject drugs (PWID) in terms of risk behaviors for HIV and HCV and access to prevention and care in the city of Haiphong, a historic hotspot for HIV and drug use. Methodology: We carried out a ‘before-after’ study from 2019 to 2020 using respondent-driven sampling method to enroll PWID. They were interviewed on their socioeconomic situation, drug use and sexual behaviors, relations to care services and tested for drugs and methadone in the urine, for HIV, HCV, and HIV plasma viral load when HIV-positive. Changes following the restrictions were assessed by comparing ‘before’ to ‘after’ data. Results: 780 PWID were enrolled. Mean age was 44 years; 94% were male. All were actively injecting heroin ‘before’, versus 56% ‘after’. Among those, frequency of consumption decreased from 24 to 17 days per month. No changes were observed in the frequency and practices of methamphetamine smoking. The proportion of PWID on MMT increased from 68.7% to 75.3%, and that of PWID engaging in risky behaviors related to drug injection decreased from 6.0% to 1.5%. No HIV seroconversions were observed; HCV incidence was 2.6/100 person-years (95% CI [0.7–6.7]). 9% of PWID reported a monthly income of less than 130USD ‘before’ versus 53% ‘after’. Conclusion: The case of Hai Phong shows that it is possible, during times of COVID-19 pandemic, to maintain access to harm reduction and care and to prevent HIV and HCV transmission among PWID in a resource-limited setting where severe social distancing restrictions are implemented. Further research is needed to assess the consequences of long-term economic difficulties and the impact of actual spread of SARS-Cov2 that has since emerged in Haiphong.A cohort study revealed high mortality among people who inject drugs in Hai Phong, Vietnam
AbstractVinh, 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. (n.d.).Publication year
2021Journal title
Journal of Clinical EpidemiologyVolume
139Page(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 Injections
AbstractDes Jarlais, D. C., Arasteh, K., Barnes, D. M., Feelemyer, J., Berg, H., Raag, M., Talu, A., Org, G., Tross, S., & Uuskula, A. (n.d.).Publication year
2021Journal title
Frontiers in SociologyVolume
6AbstractInjecting 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 drugs
AbstractLinton, 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. (n.d.).Publication year
2021Journal title
International Journal of Drug PolicyVolume
94AbstractBackground: 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 source
AbstractMeltzer, G. Y., Chang, V. W., Lieff, S. A., Grivel, M. M., Yang, L. H., & Des Jarlais, D. C. (n.d.).Publication year
2021Journal title
International journal of environmental research and public healthVolume
18Issue
21AbstractNon-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 managers
AbstractTalal, 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. (n.d.).Publication year
2021Journal title
Journal of Substance Abuse TreatmentVolume
127AbstractAlthough 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?
AbstractWise, 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. (n.d.).Publication year
2021Journal title
International Journal of Drug PolicyVolume
95AbstractBackground: 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 study
AbstractDes Jarlais, D. C., Feelemyer, J., McKnight, C., Knudtson, K., & Glick, S. N. (n.d.).Publication year
2021Journal title
Harm Reduction JournalVolume
18Issue
1AbstractBackground: 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 drugs
AbstractDurand, 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. (n.d.).Publication year
2021Journal title
Journal of Clinical MedicineVolume
10Issue
21AbstractAntiviral 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
AbstractWise, 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. (n.d.).Publication year
2021Journal title
Archives of Sexual BehaviorVolume
50Issue
7Page(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.Rapid point-of-care (POC) testing for Hepatitis C antibodies in a very high prevalence setting: persons injecting drugs in Tallinn, Estonia
AbstractUusküla, A., Talu, A., Rannap, J., Barnes, D. M., & Jarlais, D. D. (n.d.).Publication year
2021Journal title
Harm Reduction JournalVolume
18Issue
1AbstractBackground: 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.
AbstractGrivel, M. M., Lieff, S. A., Meltzer, G. Y., Chang, V. W., Yang, L. H., & Jarlais, D. C. (n.d.).Publication year
2021Journal title
Stigma and HealthVolume
6Issue
4Page(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.Syringe Services Programs’ Role in Ending the HIV Epidemic in the U.S.: Why We Cannot Do It Without Them
AbstractBroz, D., Carnes, N., Chapin-Bardales, J., Des Jarlais, D. C., Handanagic, S., Jones, C. M., McClung, R. P., & Asher, A. K. (n.d.).Publication year
2021Journal title
American journal of preventive medicineVolume
61Issue
5Page(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.