High seroprevalence epidemics among IDUs pose two critical inter-related questions for public health: how to halt ongoing HIV transmission among IDUs and how to halt the transition from a concentrated IDU epidemic to a generalized heterosexual epidemic. While there are several interventions that have been shown effective in reducing risk behavior among IDUs, no single intervention is effective for all IDUs. Thus, these inter-related problems provide an ideal context for studying combinations of prevention programs. There are five Specific Aims in the proposed research: 1.Conduct systematic reviews of social structural and behavioral interventions to reduce injecting and sexual risk behavior, and biomedical interventions (drug abuse treatment, STI treatment) to reduce risk behavior among injecting drug users, and interventions to build community and policy support for HIV prevention among IDUs. For interventions with previous systeml interventions to reduce injecting and sexual risk behaviors among IDUs and of combinations of interventions at different levels of coverage, including optimization strategies for reducing HIV transmission among IDUs and from IDUs to non-drug using sexual partners 3. Monitor the ongoing high seroprevalence HIV epidemics among IDUs in Tallinn, Estonia to assess current interventions and model an """"""""optimal"""""""" set of interventions for that epidemic. HIV prevalence is currently over 50% among IDUs in Tallinn, estimated incidence is over 20/100 person-years at risk and IDUs report high rates of multiple sexual partnerships with inconsistent condom use. 4. Conduct a pilot study of screening and treatment for sexually transmitted infections (STIs) among IDUs in Tallinn to assess feasibility and effectiveness in reducing sexual transmission among IDUs and from IDUs to non-drug injecting sexual partners. The pilot study will include biomedical intervention (screening and treatment) with a state-o transmission from IDUs to non-drug injecting sexual partners are two critical public health problems in many different countries. These inter-related problems are an ideal context for studying the effects of combined HIV prevention programs. Public health significance: Reducing HIV transmission among IDUs and preventing transmission from IDUs to non-drug injecting sexual partners are two critical public health problems in many different countries. These inter-related problems are an ideal context for studying the effects of combined HIV prevention programs.

Public Health Relevance

significance: Reducing HIV transmission among IDUs and preventing transmission from IDUs to non-drug injecting sexual partners are two critical public health problems in many different countries. These inter-related problems are an ideal context for studying the effects of combined HIV prevention programs.

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Research Project (R01)
Project #
1R01AI083035-01
Application #
7680539
Study Section
Special Emphasis Panel (ZAI1-GPJ-A (J1))
Program Officer
Sharma, Usha K
Project Start
2009-06-08
Project End
2013-05-31
Budget Start
2009-06-08
Budget End
2010-05-31
Support Year
1
Fiscal Year
2009
Total Cost
$779,183
Indirect Cost
Name
Beth Israel Medical Center (New York)
Department
Type
DUNS #
075255364
City
New York
State
NY
Country
United States
Zip Code
10003
Chan, Pui Y; Joseph, Michael A; Des Jarlais, Don C et al. (2018) Perceived effectiveness of antiretroviral therapy, self-rated health and treatment adherence among HIV-positive people who inject drugs in Estonia. Int J STD AIDS 29:13-22
Feelemyer, Jonathan; Des Jarlais, Don; Arasteh, Kamyar et al. (2015) Adherence to antiretroviral medications among persons who inject drugs in transitional, low and middle income countries: an international systematic review. AIDS Behav 19:575-83
Uusküla, Anneli; Des Jarlais, Don C; Raag, Mait et al. (2015) Combined prevention for persons who inject drugs in the HIV epidemic in a transitional country: the case of Tallinn, Estonia. AIDS Care 27:105-11
Feelemyer, Jonathan; Des Jarlais, Don; Arasteh, Kamyar et al. (2014) Retention of participants in medication-assisted programs in low- and middle-income countries: an international systematic review. Addiction 109:20-32
Feelemyer, Jonathan P; Jarlais, Don C Des; Arasteh, Kamyar et al. (2014) Changes in quality of life (WHOQOL-BREF) and addiction severity index (ASI) among participants in opioid substitution treatment (OST) in low and middle income countries: an international systematic review. Drug Alcohol Depend 134:251-258
Meader, Nicholas; Semaan, Salaam; Halton, Marie et al. (2013) An international systematic review and meta-analysis of multisession psychosocial interventions compared with educational or minimal interventions on the HIV sex risk behaviors of people who use drugs. AIDS Behav 17:1963-78
Des Jarlais, Don C; Feelemyer, Jonathan P; Modi, Shilpa N et al. (2013) High coverage needle/syringe programs for people who inject drugs in low and middle income countries: a systematic review. BMC Public Health 13:53
Abdul-Quader, Abu S; Feelemyer, Jonathan; Modi, Shilpa et al. (2013) Effectiveness of structural-level needle/syringe programs to reduce HCV and HIV infection among people who inject drugs: a systematic review. AIDS Behav 17:2878-92
Des Jarlais, Don C; Boltaev, Azizbek; Feelemyer, Jonathan et al. (2013) Gender disparities in HIV infection among persons who inject drugs in Central Asia: a systematic review and meta-analysis. Drug Alcohol Depend 132 Suppl 1:S7-12
Uusküla, Anneli; Rajaleid, Kristiina; Talu, Ave et al. (2013) A decline in the prevalence of injecting drug users in Estonia, 2005-2009. Int J Drug Policy 24:312-8

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