TY - JOUR
T1 - Combined prevention for persons who inject drugs in the HIV epidemic in a transitional country
T2 - The case of Tallinn, Estonia
AU - Uusküla, Anneli
AU - Des Jarlais, Don C.
AU - Raag, Mait
AU - Pinkerton, Steven D.
AU - Feelemyer, Jonathan
N1 - Funding Information:
Estonia’s capacity to manage its response to HIV and AIDS has increased greatly over the past decade, particularly through funding from the Global Fund to Fight HIV/ AIDS, Tuberculosis, and Malaria (The Global Fund to Fight AIDS, Tuberculosis and Malaria, 2007). Global Fund support was also instrumental in building capacity for the governmental and nongovernmental sectors to interact constructively with each other. These cooperative actions included establishing systems for channeling funds through the government to nongovernmental organizations and mechanisms for cooperation (Drew et al., 2008). These collaborative efforts resulted in several initiatives, including efforts to reduce the risk of harm faced by PWIDs by scaling up syringe exchange programs and drug treatment programs. ART is available free of charge to all HIV-infected persons in need, including those without health insurance. There has been a significant increase in the number of persons on ART over the past years: from 250 (Rüütel, Trummal, Salekesin, & Pervilhac, 2011) in 2005 to 2156 (Estonian Ministry of Social Affairs, 2012; Uusküla et al., 2011) in 2011.
Funding Information:
This work was supported by the National Institutes of Health, USA [grant number R01AI083035], [grant number P30MH052776]; Estonian Ministry of Education and Research [grant number SF0180060s09].
Publisher Copyright:
© 2014 Taylor & Francis.
PY - 2015/1/15
Y1 - 2015/1/15
N2 - The study was undertaken to assess the potential effectiveness of combined HIV prevention on the very high seroprevalence epidemic among persons who inject drugs (PWID) in Tallinn, Estonia, a transitional country. Data from community-based cross-sectional (respondent-driven sampling) surveys of PWID in 2005, 2007, 2009, and 2011 were used together with mathematical modeling of injection-associated HIV acquisition to estimate changes in injection-related HIV incidence during these periods. Utilization of one, two, or three of the interventions available in the community (needle and syringes exchange program, antiretroviral treatment [ART], HIV testing, opioid substitution treatment) was reported by 42.5%, 30.5%, and 11.5% of HIV+ and 34.7%, 36.4%, and 5.7% of HIV-PWIDs, respectively, in 2011. The modeling results suggest that the combination of needle/syringe programs and provision of ART to PWID in Tallinn substantially reduced the incidence of HIV infection in this population, from an estimated 20.7/100 person-years in 2005 to 7.5/100 person-years in 2011. In conclusion, combined prevention targeting HIV acquisition and transmission-related risks among PWID in Tallinn has paralleled the downturn of the HIV epidemic in this population.
AB - The study was undertaken to assess the potential effectiveness of combined HIV prevention on the very high seroprevalence epidemic among persons who inject drugs (PWID) in Tallinn, Estonia, a transitional country. Data from community-based cross-sectional (respondent-driven sampling) surveys of PWID in 2005, 2007, 2009, and 2011 were used together with mathematical modeling of injection-associated HIV acquisition to estimate changes in injection-related HIV incidence during these periods. Utilization of one, two, or three of the interventions available in the community (needle and syringes exchange program, antiretroviral treatment [ART], HIV testing, opioid substitution treatment) was reported by 42.5%, 30.5%, and 11.5% of HIV+ and 34.7%, 36.4%, and 5.7% of HIV-PWIDs, respectively, in 2011. The modeling results suggest that the combination of needle/syringe programs and provision of ART to PWID in Tallinn substantially reduced the incidence of HIV infection in this population, from an estimated 20.7/100 person-years in 2005 to 7.5/100 person-years in 2011. In conclusion, combined prevention targeting HIV acquisition and transmission-related risks among PWID in Tallinn has paralleled the downturn of the HIV epidemic in this population.
KW - Antiretroviral treatment
KW - HIV
KW - Opioid substitution treatment
KW - Persons who inject drugs
KW - Prevention
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U2 - 10.1080/09540121.2014.940271
DO - 10.1080/09540121.2014.940271
M3 - Article
C2 - 25054646
AN - SCOPUS:84911415275
SN - 0954-0121
VL - 27
SP - 105
EP - 111
JO - AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
JF - AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
IS - 1
ER -