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 - 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
UR - http://www.scopus.com/inward/record.url?scp=84911415275&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84911415275&partnerID=8YFLogxK
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 -