Kamyar Arasteh

Kamyar Arasteh
Kamyar Arasteh

Clinical Associate Professor of Epidemiology

Professional overview

Dr. Kamyar Arasteh’s research concerns the epidemiology of HIV infection and hepatitis, and the associated sexual and drug use risk factors. The goals of this interdisciplinary and international collaborative effort encompass harm reduction at the individual level, reducing the incidence of infections at the population level, and enhancing treatment among vulnerable groups and in countries that have a high burden of disease.

Examples of previous and ongoing work include research projects in geographically diverse locations, such as New York, Estonia, and Vietnam.  A cornerstone of these investigations has been the use of rigorous research methods.  Developing and improving research methods, with particular attention to quantitative techniques, continues to be an important focus of this work.

Education

BA, Psychology, Marshall University, Huntington, WV
MA, Psychology, Marshall University, Huntington, WV
PhD, Psychology, Texas A&M University, College Station, TX
Postdoctoral Fellow, Johns Hopkins University School of Medicine, Baltimore, MD

Areas of research and study

Drug addiction
Epidemiology
Harm reduction
Hepatitis
HIV/AIDS

Publications

Publications

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

Des Jarlais, D. C., Arasteh, K., Barnes, D. M., Feelemyer, J., Berg, H., Raag, M., Talu, A., Org, G., Tross, S., & Uuskula, A.

Publication year

2021

Journal title

Frontiers in Sociology

Volume

6
Abstract
Abstract
Injecting 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.

Hypertension, diabetes and poverty among Latinx immigrants in New York City: implications for COVID-19

Arasteh, K.

Publication year

2021

Journal title

International Journal of Migration, Health and Social Care

Volume

17

Issue

2

Page(s)

208-241
Abstract
Abstract
Purpose: The coronavirus disease (COVID-19) pandemic has affected Latinx immigrant neighborhoods in New York City (NYC) disproportionately. Poverty, hypertension and diabetes have been associated with adverse COIVD-19 outcomes. This study aims to assess the prevalence of these COVID-19 vulnerabilities among Latinx immigrants in NYC. Design/methodology/approach: Data were obtained from the 2018 New York City Community Health Survey. The relation between Latinx immigrant status and study outcomes was assessed in univariate and multivariable regression models. Findings: Latinx immigrants were 1.3 times (95% confidence interval: 1.2–1.5) more likely to have hypertension and 2.5 times (95% confidence interval: 1.9–3.2) to have diabetes, compared to the US-born Whites after adjusting for age. They were 46.5 times (95% confidence interval: 24.3–88.8) more likely to live in a neighborhood with high poverty, eight times more likely (95% confidence interval: 5.5–11.6) not to have had enough food in the previous six months and 1.4 times more likely (95% confidence interval: 1.2–1.6) to lack health insurance coverage, compared to the US-born Whites. Practical implications: These findings highlight the greater vulnerabilities of Latinx immigrants in NYC to COVID-19 in the year prior to the pandemic. Poverty, food insecurity, hostile immigration policies and lack of access to health care exacerbate health disparities among Latinx immigrants in NYC. Originality/value: This study provides a public health perspective for understanding the association of health disparities and socioeconomic conditions of Latinx immigrants in NYC.

Prevalence of Comorbidities and Risks Associated with COVID-19 Among Black and Hispanic Populations in New York City: an Examination of the 2018 New York City Community Health Survey

Arasteh, K.

Publication year

2021

Journal title

Journal of Racial and Ethnic Health Disparities

Volume

8

Issue

4

Page(s)

863-869
Abstract
Abstract
Background: The coronavirus disease (COVID-19) pandemic has affected Blacks and Hispanics in New York City (NYC) disproportionately. This study aims to assess the relationship of race/ethnicity with COVID-19 associated factors such as hypertension, diabetes, neighborhood poverty, and frontline work, in NYC. Methods: The 2018 New York City Community Health Survey was used to examine the association of hypertension, diabetes, and neighborhood poverty level with race/ethnicity in log-binomial regression models. Number of intensive care unit (ICU) beds and the distribution of frontline workers were acquired from the US Census, the State of New York Department of Labor, and Centers for Medicare and Medicaid Services. Results: Neighborhoods with high poverty level had a greater risk of hypertension among Blacks (relative risk (RR), 95% confidence interval (CI): 3.4, 1.9–6.4) and diabetes among Hispanics (RR, 95% CI: 5.5, 2.2–14.0), compared with Whites in the lowest poverty neighborhoods. Disproportionately greater percentages of frontline workers were comprised of Blacks (29.4%, 95% CI: 29.3–29.5%) and Hispanics (35.5%, 95% CI: 35.3–35.6%). Predominantly Black and Hispanic boroughs with greater level of poverty had one ICU bed per 900 adults of 60 years of age or older, compared with one ICU bed per 452 in predominantly White boroughs with less poverty. Conclusion: The greater prevalence of the factors associated with COVID-19 infection and adverse outcomes puts Black and Hispanic populations in NYC at a greater risk. These factors are also related to poverty and should be mitigated together with reducing racial/ethnic inequities.

Self-reported Hazardous Drinking, Hypertension, and Antihypertensive Treatment Among Hispanic Immigrants in the US National Health Interview Survey, 2016–2018

Arasteh, K.

Publication year

2021

Journal title

Journal of Racial and Ethnic Health Disparities

Volume

8

Issue

3

Page(s)

638-647
Abstract
Abstract
Compared to the US-born population, Hispanic immigrants are reported to have lower age-adjusted prevalence of hypertension. However, country of origin, race/ethnicity, and risk behaviors associated with acculturation, including hazardous drinking, can affect the prevalence of hypertension. Additionally, health disparities across immigration/nativity status may be associated with suboptimal antihypertensive treatment and control of hypertension. In the present study, population-based data from the years 2016 to 2018 of the National Health Interview Survey (NHIS) were analyzed to assess the association of nativity status and hazardous drinking with hypertension among US-born and foreign-born Hispanic populations. Age-adjusted prevalence of past-year hypertension among foreign-born Hispanics was lower than US-born Hispanics. However, the proportion of Hispanic immigrants who had their blood pressure checked by a healthcare professional was also smaller than US-born Hispanics, suggesting that the prevalence of hypertension among Hispanic immigrants may be underreported. Hazardous drinking was associated with decreased odds of antihypertensive treatment among the Hispanic immigrants.

The methamphetamine epidemic among persons who inject heroin in Hai Phong, Vietnam

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Publication year

2021

Journal title

Journal of Substance Abuse Treatment

Volume

126
Abstract
Abstract
Aims: 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 Nam

Des 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.

Publication year

2021

Journal title

PloS one

Volume

16

Issue

11
Abstract
Abstract
AIMS: 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

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

Des Jarlais, D. C., Huong, D. T., Oanh, K. T. H., Feelemyer, J. P., Arasteh, K., 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.

Publication year

2020

Journal title

AIDS

Volume

34

Issue

15

Page(s)

2305-2311
Abstract
Abstract
Objective: To determine whether it is possible to ‘end an HIV epidemic’ among persons who inject drugs (PWID) in a low/middle income country. Design: Serial cross-sectional surveys with a cohort of HIV seronegative participants with 6-month follow-up visits recruited from surveys. Methods: Surveys of PWID using respondent driven and snowball sampling were conducted in 2016, 2017, 2018, and 2019 (N ¼ 1383, 1451, 1444, and 1268). HIV recency testing was used to identify possible seroconversions in the window period prior to study entry. Structured interviews covering drug use histories, current drug use, and use of HIV-related services were administered by trained interviewers. Urinalysis was used to confirm current drug use. HIV and hepatitis C virus testing were conducted. Electronic fingerprint readers were used to avoid multiple participation in each survey and to link participants across surveys. A cohort of HIV seronegative participants with 6-month follow-up visits was recruited from the surveys, 480 from 2016, 233 from 2017, and 213 from 2018. Results: Participants were predominantly male (95%), mean age approximately 40, all reported injecting heroin, HIV prevalence ranged between 26 and 30%. We had three seroconversions in 1483 person-years at risk (PYAR) in the cohort study, and 0 in 696 PYAR among repeat survey participants, and 0 seroconversions in 1344 PYAR in recency testing. Overall HIV incidence was 0.085/100 PYAR, 95% confidence interval 0.02 – 0.25/100 PYAR. Conclusion: The data from Hai Phong clearly demonstrate that it is possible to achieve very low HIV incidence – ‘end an HIV epidemic’ – among PWID in a middle-income country.

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

Des Jarlais, D. C., Feelemyer, J., Arasteh, K., LaKosky, P., & Szymanowski, K.

Publication year

2020

Journal title

American journal of public health

Volume

110

Issue

4

Page(s)

517-519
Abstract
Abstract
Objectives. To report on the expansion of syringe service programs (SSPs) in the United States from 2015 to 2018. Methods. We obtained data from records of the Buyers' Club of the Dave Purchase Project/North American Syringe Exchange Network (NASEN), including the number of US SSPs and the numbers of sterile syringes purchased by programs. We conducted a subset analysis of states with high numbers of counties defined as "vulnerable" by the Centers for Disease Control and Prevention. Results. SSP participation in the Buyers' Club increased from 141 in 2015 to 292 in 2018, with an increase in syringes purchased from 42 million to 88 million. In addition to these large increases in numbers of programs and in syringes purchased, there were also indications of instability among new programs in vulnerable states. Conclusions. There have been substantial increases in the number of programs established and the number of syringes distributed in response to the opioid epidemic. Ensuring high-quality services in these new programs will be critical to successfully addressing the current epidemic.

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.

HIV control programs reduce HIV incidence but not HCV incidence among people who inject drugs in HaiPhong, Vietnam

Molès, J. P., Vallo, R., Khue, P. M., Huong, D. T., Oanh, K. T. H., Thoa, N. T., Giang, H. T., Thanh, N. T. T., Vinh, V. H., Bui Thi, T. A., Peries, M., Arasteh, K., Quillet, C., Feelemyer, J., Michel, L., Jarlais, D. D., Laureillard, D., & Nagot, N.

Publication year

2020

Journal title

Scientific reports

Volume

10

Issue

1
Abstract
Abstract
In Vietnam, harm reduction programs to control HIV among people who inject drugs (PWID) were implemented approximately 10 years ago. Since then, the HIV prevalence has declined in this population, however, the impact of these programs on the rate of new HIV and Hepatitis C (HCV) infections remains unknown as high mortality can exceed the rate of new infections. We evaluated HIV and HCV incidences in a cohort of active PWID in HaiPhong in 2014, who were recruited from a community-based respondent driven sampling (RDS) survey and followed for 1 year. Only HIV-negative or HCV-negative participants not on medication assisted treatment (MAT) were eligible. HIV/HCV serology was tested at enrollment and at 32- and 64-week follow-up visits. Among 603 RDS participants, 250 were enrolled in the cohort, including 199 HIV seronegative and 99 HCV seronegative PWID. No HIV seroconversion was reported during the 206 person-years (PY) of follow-up (HIV incidence of 0/100PY, one-sided 97.5%CI:0-1.8/100 PY). Eighteen HCV seroconversions were reported for an incidence of 19.4/100 PY (95%CI;11.5-30.7). In multivariate analysis, “Injecting more than twice daily” was associated with HCV seroconversion with an adjusted odds ratio of 5.8 (95%CI;1.8–18.1). In Hai Phong, in a context that demonstrates the effectiveness of HIV control programs, the HCV incidence remains high. New strategies such as mass access to HCV treatment should be evaluated in order to tackle HCV transmission among PWID.

Geographic distribution of risk ("Hotspots") for HIV, HCV, and drug overdose among persons who use drugs in New York City: The importance of local history

Implementing an Updated “Break the Cycle” Intervention to Reduce Initiating Persons into Injecting Drug Use in an Eastern European and a US “opioid epidemic” Setting

Injection and Heterosexual Risk Behaviors for HIV Infection Among Non-gay Identifying Men Who Have Sex with Men and Women

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

Publication year

2019

Journal title

AIDS and Behavior

Volume

23

Issue

12

Page(s)

3315-3323
Abstract
Abstract
Non-gay identifying men who have sex with men and women (MSMW) are an important subgroup of men who have sex with men (MSM) and have been underrepresented in studies of MSM that only use gay venues to draw their samples. We assessed heterosexual and drug use risks of MSMW who use drugs in a sample of male entrants to the Mount Sinai Beth Israel drug treatment programs from 2005 to 2018. Blood samples were collected and tested for HIV and HSV-2 infections. Among HIV seronegative participants, MSMW had significantly greater odds of sharing used needles with others, and reporting unprotected sex with female casual partners and female commercial sex partners, compared to their counterparts who reported sex with women exclusively (MSWE). Although not recruited from gay venues, MSMW had a significantly higher HIV prevalence than MSWE (23% vs. 10%, p < 0.001). Interventions that are specifically tailored to HIV prevention among MSMW are needed to ameliorate the prevalence of HIV risks and infection.

Prescription opiate analgesics, heroin, HIV and HCV among persons who inject drugs in New York City, 2016-2018

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

Publication year

2019

Journal title

Drug and alcohol dependence

Volume

204
Abstract
Abstract
Objectives: Assess relationships among non-medical use of prescription opioid analgesics (POAs), heroin use, and HIV and hepatitis C (HCV) infection among persons who inject drugs (PWID) in New York City, 2016–2018. Methods: PWID (N = 134) were recruited from Mount Sinai Beth Israel drug treatment programs. HIV seropositive persons were oversampled. A questionnaire was administered, and serum samples were collected for HIV and HCV testing. Analyses were stratified by HIV serostatus and compared those who had used POAs to those who had not used POAs. Results: Among the participants, 97% reported injecting heroin, 44% reported injecting cocaine, and 47% reported smoking crack cocaine in the 6 months prior to the interview. There were 66% who reported oral non-medical use of POAs, with 42% using oral POAs in the previous 6 months. There was a clear historical pattern in median year of first injection for different groups: HIV seropositive persons (1985), HIV seronegative persons who never used POAs (1999), and HIV seronegative persons who used POAs (2009). By the time of interview (2016–2018), however, almost all participants (97%) reported injecting heroin. All PWID who reported using POAs also reported injecting heroin. Conclusions: Non-medical POA use among PWID was very common and should not be considered a separate drug use epidemic, but as an additional component of the continuing heroin/poly-drug use epidemic, itself a part of the syndemic of opioid use, stimulant use, overdose, HCV and HIV occurring in New York City.

Hepatitis C virus prevalence and estimated incidence among new injectors during the opioid epidemic in New York City, 2000–2017: Protective effects of non-injecting drug use

Des Jarlais, D. C., Arasteh, K., Feelemyer, J., McKnight, C., Barnes, D. M., Perlman, D. C., Uuskula, A., Cooper, H. L., & Tross, S.

Publication year

2018

Journal title

Drug and alcohol dependence

Volume

192

Page(s)

74-79
Abstract
Abstract
Objective: Assess hepatitis C virus (HCV) prevalence and incidence among person who began injecting drugs during the opioid epidemic in New York City (NYC) and identify possible new directions for reducing HCV infection among persons who inject drugs. Methods: 846 persons who began injecting drugs between 2000 and 2017 were recruited from persons entering Mount Sinai Beth Israel substance use treatment programs. A structured interview was administered and HCV antibody testing conducted. Protective effects of non-injecting drug use were examined among persons who “reversed transitioned” to non-injecting drug use and persons who used non-injected heroin in addition to injecting. Results: Participants were 79% male, 41% White, 15% African-American, 40% Latinx, with a mean age of 35. Of those who began injecting in 2000 or later, 97 persons (11%) “reverse transitioned” back to non-injecting drug use. Reverse transitioning was strongly associated with lower HCV seroprevalence (30% versus 47% among those who continued injecting, p < 0.005). Among those who continued injecting, HCV seropositivity was inversely associated with current non-injecting heroin use (AOR = 0.72, 95%CI 0.52-0.99). HCV incidence among persons continuing to inject was estimated as 13/100 person-years. HCV seropositive persons currently injecting cocaine were particularly likely to report behavior likely to transmit HCV. Conclusions: Similar to other locations in the US, NYC is experiencing high rates of HCV infection among persons who have begun injecting since 2000. New interventions that facilitate substitution of non-injecting for injecting drug use and that reduce transmission behavior among HCV seropositives may provide additional methods for reducing HCV transmission.

Heterosexual male and female disparities in HIV infection at the end of an epidemic: HIV infection among persons who inject drugs in New York City, 2001–2005 and 2011–2015

Increased Methamphetamine Use among Persons Who Inject Drugs in Hai Phong, Vietnam, and the Association with Injection and Sexual Risk Behaviors

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Publication year

2018

Journal title

Journal of Psychoactive Drugs

Volume

50

Issue

5

Page(s)

382-389
Abstract
Abstract
Methamphetamine use has increased significantly in Southeast Asia in the last 5–10 years, but there is little research on risk behaviors associated with the increase in this region. We evaluate injection and sexual risk behaviors associated with current methamphetamine use among heterosexual persons who inject drugs (PWID) in Hai Phong, Vietnam. We recruited 1336 PWID and assessed associations between methamphetamine use, injection and sexual risk behaviors, stratified by HIV serostatus. There were several statistically significant associations between methamphetamine use and sexual risk behaviors among HIV-positive PWID, but we did not find any associations between methamphetamine use and injection risk behaviors. Methamphetamine may increase the likelihood of PWID transmitting HIV to non-injecting primary sexual partners, as it can reduce ART adherence and can lead to weakening of the immune system and increased HIV viral loads. All participants were injecting heroin, and methamphetamine use may interfere with opiate use treatment. Public health efforts should focus on the large increase in methamphetamine use and the associated sexual risk behaviors. Emphasis on sexual risk behavior, particularly among those who are HIV-positive, in conjunction with continued monitoring of ART adherence and HIV viral loads, is critical.

Potential geographic "hotspots" for drug-injection related transmission of HIV and HCV and for initiation into injecting drug use in New York city, 2011-2015, with implications for the current opioid epidemic in the US

Des Jarlais, D. C., Cooper, H. L., Arasteh, K., Feelemyer, J., McKnight, C., & Ross, Z.

Publication year

2018

Journal title

PloS one

Volume

13

Issue

3
Abstract
Abstract
Objective We identified potential geographic “hotspots” for drug-injecting transmission of HIV and hepatitis C virus (HCV) among persons who inject drugs (PWID) in New York City. The HIV epidemic among PWID is currently in an “end of the epidemic” stage, while HCV is in a continuing, high prevalence (> 50%) stage. Methods We recruited 910 PWID entering Mount Sinai Beth Israel substance use treatment programs from 2011–2015. Structured interviews and HIV/ HCV testing were conducted. Residential ZIP codes were used as geographic units of analysis. Potential “hotspots” for HIV and HCV transmission were defined as 1) having relatively large numbers of PWID 2) having 2 or more HIV (or HCV) seropositive PWID reporting transmission risk—passing on used syringes to others, and 3) having 2 or more HIV (or HCV) seronegative PWID reporting acquisition risk—injecting with previously used needles/syringes. Hotspots for injecting drug use initiation were defined as ZIP codes with 5 or more persons who began injecting within the previous 6 years. Results Among PWID, 96% injected heroin, 81% male, 34% White, 15% African-American, 47% Latinx, mean age 40 (SD = 10), 7% HIV seropositive, 62% HCV seropositive. Participants resided in 234 ZIP codes. No ZIP codes were identified as potential hotspots due to small numbers of HIV seropositive PWID reporting transmission risk. Four ZIP codes were identified as potential hotspots for HCV transmission. 12 ZIP codes identified as hotspots for injecting drug use initiation. Discussion For HIV, the lack of potential hotspots is further validation of widespread effectiveness of efforts to reduce injecting-related HIV transmission. Injecting-related HIV transmission is likely to be a rare, random event. HCV prevention efforts should include focus on potential hotspots for transmission and on hotspots for initiation into injecting drug use. We consider application of methods for the current opioid epidemic in the US.

Risk behaviors for hiv and hcv infection among people who inject drugs in hai phong, viet nam, 2014

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Publication year

2018

Journal title

AIDS and Behavior

Volume

22

Issue

7

Page(s)

:2161-2171
Abstract
Abstract
We examined the potential for HIV and hepatitis C (HCV) transmission across persons who inject drugs (PWID), men-who-have-sex-with-men (MSM) and female commercial sex workers (CSW) PWID and the potential for sexual transmission of HIV from PWID to the general population in Hai Phong, Viet Nam. Using respondent driven and convenience sampling we recruited 603 participants in 2014. All participants used heroin; 24% used non-injected methamphetamine. HIV prevalence was 25%; HCV prevalence was 67%. HIV infection was associated with HCV prevalence and both infections were associated with length of injecting career. Reported injecting risk behaviors were low; unsafe sexual behavior was high among MSM-PWID and CSW-PWID. There is strong possibility of sexual transmission to primary partners facilitated by methamphetamine use. We would suggest future HIV prevention programs utilize multiple interventions including ‘‘treatment as prevention’’ to potential sexual transmission of HIV among MSM and CSW-PWID and from PWID to the general population.

Using dual capture/recapture studies to estimate the population size of persons who inject drugs (PWID) in the city of Hai Phong, Vietnam

Des Jarlais, D., Khue, P. M., Feelemyer, J., Arasteh, K., Thi Huong, D., Thi Hai Oanh, K., Thi Giang, H., Thi Tuyet Thanh, N., Vinh, V. H., Heckathorn, D. D., Moles, J. P., Vallo, R., Quillet, C., Rapoud, D., Michel, L., Laureillard, D., Hammett, T., & Nagot, N.

Publication year

2018

Journal title

Drug and alcohol dependence

Volume

185

Page(s)

106-111
Abstract
Abstract
Background: Good estimates of key population sizes are critical for appropriating resources to prevent HIV infection. We conducted two capture/recapture studies to estimate the number of PWID currently in Hai Phong, Vietnam. Methods: A 2014 respondent-driven sampling (RDS) survey served as one capture, and distribution of cigarette lighters at drug use “hotspots” in 2016 served as another “capture.” A 2016 survey using RDS, conducted 1 week after lighter distribution, served as “recapture” for both captures. Recaptured participants in the two surveys were identified with a computerized fingerprint reader. Recaptured participants from the lighter distribution were asked to show their lighters. Results: 1385 participants were included in the “recapture” survey. They were 94% male and had a median age of 39. All (100%) injected heroin, and HIV prevalence was 30%. 144 of the 603 participants in the 2014 survey and 152 of the 600 PWID who had received lighters were “recaptured” in the 2016 survey. After adjusting for police suppression of drug use hotspots and conducting sensitivity analyses, our best estimate of the population size from the lighter recapture was 4617 (95% CI: 4090–5143), and our best estimate from the 2014 survey recapture was 5220 (95% CI: 4568–5872). A combined best estimate of the PWID population in Hai Phong is 5000, range 4000–6000. Conclusions: The capture/recapture studies produced consistent estimates. Adding a lighter/token distribution to planned RDS surveys may provide an inexpensive method for estimating PWID population size. Analyses of the estimates should include contextual information about the local drug scene.

Decline in herpes simplex virus type 2 among non-injecting heroin and cocaine users in New York City, 2005 to 2014: Prospects for avoiding a resurgence of human immunodeficiency virus

Des Jarlais, D. C., Arasteh, K., Feelemyer, J., McKnight, C., Tross, S., Perlman, D. C., Campbell, A. N., Hagan, H., & Cooper, H. L.

Publication year

2017

Journal title

Sexually Transmitted Diseases

Volume

44

Issue

2

Page(s)

85-90
Abstract
Abstract
Background: Herpes simplex virus type 2 (HSV-2) infection increases both susceptibility to and transmissibility of human immunodeficiency virus (HIV), and HSV-2 and HIV are often strongly associated in HIV epidemics. We assessed trends in HSV-2 prevalence among non-injecting drug users (NIDUs) when HIV prevalence declined from 16% to 8% among NIDUs in New York City. Methods: Subjects were current non-injecting users of heroin and/or cocaine and who had never injected illicit drugs. Three thousand one hundred fifty-seven NIDU subjects were recruited between 2005 and 2014 among persons entering Mount Sinai Beth Israel substance use treatment programs. Structured interviews, HIV, and HSV-2 testing were administered. Change over time was assessed by comparing 2005 to 2010 with 2011 to 2014 periods. Herpes simplex virus type 2 incidence was estimated among persons who participated in multiple years. Results: Herpes simplex virus type 2 prevalence was strongly associated with HIV prevalence (odds ratio, 3.9; 95% confidence interval, 2.9-5.1) from 2005 to 2014. Herpes simplex virus type 2 prevalence declined from 60% to 56% (P = 0.01). The percentage of NIDUs with neither HSV-2 nor HIVinfection increased from37% to 43%, (P < 0.001); the percentagewith HSV-2/HIV coinfection declined from 13% to 6% (P < 0.001). Estimated HSV-2 incidence was 1 to 2/100 person-years at risk. Conclusions: There were parallel declines in HIV and HSV-2 among NIDUs in New York City from 2005 to 2014. The increase in the percentage of NIDUs with neither HSV-2 nor HIV infection, the decrease in the percentage with HSV-2/HIV coinfection, and the low to moderate HSV-2 incidence suggest some population-level protection against resurgence of HIV. Prevention efforts should be strengthened to end the combined HIV/HSV-2 epidemic among NIDUs in New York City.

Decline in HSV-2 among non-injecting Heroin and Cocaine users in New York City, 2005-2014: potential protection against HIV resurgence

Des Jarlais, D., Arasteh, K., Feelemyer, J., Mcknight, C., Tross, S., Perlman, D., Campbell, A. N. C., Hagan, H., & Cooper, H. L. F.

Publication year

2017

Journal title

Sexually Transmitted Diseases

Page(s)

85-90

Racial/ethnic disparities at the end of an HIV epidemic: Persons who inject drugs in New York City, 2011-2015

Des Jarlais, D. C., Arasteh, K., McKnight, C., Feelemyer, J., Tross, S., Perlman, D., Friedman, S., & Campbell, A.

Publication year

2017

Journal title

American journal of public health

Volume

107

Issue

7

Page(s)

1157-1163
Abstract
Abstract
Objectives. To examine whether racial/ethnic disparities persist at the "end of the HIV epidemic" (prevalence of untreated HIV infection < 5%; HIV incidence < 0.5 per 100 person-years) among persons who inject drugs (PWID) in New York City. Methods.We recruited 2404 PWID entering New York City substance use treatment in 2001 to 2005 and 2011 to 2015. We conducted a structured interview, and testing for HIV and herpes simplex virus 2 (HSV-2; a biomarker for high sexual risk). We estimated incidence by using newly diagnosed cases of HIV. Disparity analyses compared HIV, untreated HIV, HIV-HSV-2 coinfection, HIV monoinfection, and estimated HIV incidence among Whites, African Americans, and Latinos. Results. By 2011 to 2015, Whites, African Americans, and Latino/as met both criteria of our operational "end-of-the-epidemic" definition. All comparisons that included HIV-HSV-2-coinfected persons had statistically significant higher rates of HIV among racial/ethnic minorities. No comparisons limited to HIV monoinfected persons were significant. Conclusions. "End-of-the-epidemic" criteria were met among White, African American, and Latino/a PWID in New York City, but elimination of disparities may require a greater focus on PWID with high sexual risk.

What happened to the HIV epidemic among non-injecting drug users in New York City?

Des Jarlais, D. C., Arasteh, K., McKnight, C., Feelemyer, J., Campbell, A. N., Tross, S., Cooper, H. L., Hagan, H., & Perlman, D. C.

Publication year

2017

Journal title

Addiction

Volume

112

Issue

2

Page(s)

290-298
Abstract
Abstract
Background and aims: HIV has reached high prevalence in many non-injecting drug user (NIDU) populations. The aims of this study were to (1) examine the trend in HIV prevalence among non-injecting cocaine and heroin NIDUs in New York City, (2) identify factors potentially associated with the trend and (3) estimate HIV incidence among NIDUs. Design: Serial-cross sectional surveys of people entering drug treatment programs. People were permitted to participate only once per year, but could participate in multiple years. Setting: Mount Sinai Beth Israel drug treatment programs in New York City, USA. Participants: We recruited 3298 non-injecting cocaine and heroin users from 2005 to 2014. Participants were 78.7% male, 6.1% white, 25.7% Hispanic and 65.8% African American. Smoking crack cocaine was the most common non-injecting drug practice. Measures: Trend tests were used to examine HIV prevalence, demographics, drug use, sexual behavior and use of antiretroviral treatment (ART) by calendar year; χ2 and multivariable logistic regression were used to compare 2005–10 versus 2011–14. Findings: HIV prevalence declined approximately 1% per year (P < 0.001), with a decline from 16% in 2005–10 to 8% in 2011–14 (P < 0.001). The percentages of participants smoking crack and having multiple sexual partners declined and the percentage of HIV-positive people on ART increased. HIV incidence among repeat participants was 1.2 per 1000 person-years (95% confidence interval = 0.03/1000–7/1000). Conclusions: HIV prevalence has declined and a high percentage of HIV-positive non-injecting drug users (NIDUs) are receiving antiretroviral treatment, suggesting an end to the HIV epidemic among NIDUs in New York City. These results can be considered a proof of concept that it is possible to control non-injecting drug use related sexual transmission HIV epidemics.

Contact

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