Project dates: March 2015 - January 2021
Combined prevention and care for HIV among persons who inject drugs (PWID) has led to dramatic reductions in injecting-related HIV transmission in a number of locations around the world. The implementation of multiple interventions at the same time has shown effects much greater than the effects of interventions given independently. This research will examine the impact of giving multiple evidence-based interventions on reducing initiation into injecting drug use. The study will be conducted in two sites: Tallinn, Estonia, which has very high rates of HIV infection among new drug injectors, and New York City, USA, where there is a growing problem of prescription opiate users transitioning to heroin injecting. Interventions with demonstrated effectiveness in reducing initiation into drug injecting will be included, and mathematical modeling will be used to examine the effects of combining the interventions. Reducing initiation into injecting drug use would not only reduce transmission of blood-borne viruses (HIV and HCV), but also lessen the many other individual and societal problems associated with injecting drug use.Abstract on NIH RePORTER
The fentanyl epidemic in Estonia: Opportunities for a comprehensive public health response
Lancet Psychiatry, 6 (12), 985. doi: 10.1016/S2215-0366(19)30436-5.
Des Jarlais D, Uuskula A, Talu A, Barnes DM, Raag M, Arasteh K, Org G, Demarest D, Feelemyer J, Berg H, Tross S (2019).
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
AIDS and Behavior, 23 (9), 2304-2314. doi: 10.1007/s10461-019-02467-y. PMCID: PMC6746607.
Barnes DM, Des Jarlais DC, Wolff M, Feelemyer J, Tross S (2018).
A qualitative study of persons who inject drugs but who have never helped others with first injections: How their views on helping contrast with the views of persons who have helped with first injections, and implications for interventions
Harm Reduction Journal, 15 (1), 43. doi: 10.1186/s12954-018-0250-x. PMCID: PMC6114536.
Uuskula A, Barnes DM, Raag M, Talu A, Tross S, Des Jarlais DC (2018).
Frequency and factors associated with providing injection initiation assistance in Tallinn, Estonia
Drug and Alcohol Dependence, 188, 64-70. doi: 10.1016/j.drugalcdep.2018.03.048. PMCID: PMC6875682.
Uuskula A, Raag M, Vorobjov S, Des Jarlais D (2018).
Another frontier for harm reduction: Contraceptive needs of females who inject drugs in Estonia, a cross-sectional study
Harm Reduction Journal, 15 (1), 10. doi: 10.1186/s12954-018-0215-0. PMCID: PMC5838942.
Werb D, Bluthenthal RN, Kolla G, Strike C, Kral AH, Uuskula A, Des Jarlais D (2018).
Preventing injection drug use initiation: State of the evidence and opportunities for the future
Journal of Urban Health, 95 (1), 91-98. doi: 10.1007/s11524-017-0192-8. PMCID: PMC5862695.
Des Jarlais DC, Kerr T, Carrieri P, Feelemyer J, Arasteh K (2016).
HIV infection among persons who inject drugs: Ending old epidemics and addressing new outbreaks
AIDS, 30 (6), 815-826. doi: 10.1097/QAD.0000000000001039. PMCID: PMC4785082.