Publications by authors named "Don des Jarlais"

Background: Syringe services programs (SSPs) provide harm reduction supplies and services to people who use drugs and are often required by funders or partners to collect data from program participants. SSPs can use these data during monitoring and evaluation (M&E) to inform programmatic decision making, however little is known about facilitators and barriers to collecting and using data at SSPs.

Methods: Using the Consolidated Framework for Implementation Research (CFIR), we conducted 12 key informant interviews with SSP staff to describe the overall landscape of data systems at SSPs, understand facilitators and barriers to data collection and use at SSPs, and generate recommendations for best practices for data collection at SSPs.

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Background: Persons who inject drugs (PWID) may be unengaged with healthcare services and face an elevated risk of severe morbidity and mortality associated with COVID-19 due to chronic diseases and structural inequities. However, data on COVID-19 vaccine uptake, particularly booster vaccination, among PWID are limited. We examined COVID-19 vaccine uptake and factors associated with booster vaccination among PWID in New York City (NYC).

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Background: The prevalence of hepatitis C virus (HCV) among people who inject drugs (PWID) is between 50-70%. Prior systematic reviews demonstrated that PWID have similar direct acting antiviral treatment outcomes compared to non-PWID; however, reviews have not examined treatment outcomes by housing status. Given the links between housing and health, identifying gaps in HCV treatment can guide future interventions.

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Background: Excess all-cause mortality is a key indicator for assessing direct and indirect consequences of injection drug use and data are warranted to delineate sub-populations within people who inject drugs at higher risk of death. Our aim was to examine mortality and factors associated with mortality among people who inject drugs in Estonia.

Methods: Retrospective cohort study using data from people who inject drugs recruited in the community with linkage to death records.

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Background: The co-occurrence of substance use disorder and mental disorder, known as dual diagnosis, has a distressingly high prevalence among individuals grappling with either of these conditions. Mood disorders, especially depression, constitute a substantial burden for People Who Inject Drugs (PWID) and a significant public health concern in Vietnam. Identifying risk factors for depression in PWID is imperative for the development of targeted interventions.

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The desired performance of nucleic acid testing (NAT) may vary if used for disease diagnosis or for the evaluation of the therapeutic efficacy of a treatment, although in most cases, the same assay is used. However, these tests may not be affordable in many situations including in low/middle income countries that in response have developed domestic assays. Given the example of HCV NAT among people who inject drugs in Vietnam, we aimed at evaluating a domestic assay versus an FDA- and CE-approved assay.

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Aims: We measured the association between a history of incarceration and HIV positivity among people who inject drugs (PWID) across Europe.

Design, Setting And Participants: This was a cross-sectional, multi-site, multi-year propensity-score matched analysis conducted in Europe. Participants comprised community-recruited PWID who reported a recent injection (within the last 12 months).

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Article Synopsis
  • - The study evaluated the effectiveness of self-reported adherence to antiretroviral therapy (ART) as a substitute for HIV viral load testing among people who inject drugs (PWID) in Hai Phong, Vietnam.
  • - Researchers analyzed data from 792 PWID over two years, focusing on the accuracy of self-reporting ART adherence and its correlation with actual HIV viral load levels, finding a positive predictive value (PPV) above 90%.
  • - The findings indicate that in settings lacking access to viral load testing, self-reported ART adherence could help prioritize which PWID may need viral load testing, with high adherence generally suggesting effective HIV suppression regardless of recent methamphetamine use.
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Background: Most people who inject drugs (PWID) in Iran have not undergone recent HIV testing. While PWID face barriers when seeking HIV testing at health facilities, HIV self-testing (HIVST) could be a promising approach to improve HIV testing uptake. We examined the awareness and willingness to use HIVST among PWID in Iran.

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Background: Towards hepatitis C elimination among people who inject drugs (PWID), we assessed the effectiveness of a strategy consisting of a community-based respondent-driven sampling (RDS) as wide screening, a simplified and integrated hospital-based care, and prevention of reinfection supported by community-based organisations (CBO), in Hai Phong, Vietnam.

Methods: Adults who injected heroin were enrolled in a RDS survey implemented in two CBO premises. Rapid HIV and HCV tests were done on site, and blood was taken for HCV RNA testing.

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The purpose of this study is to test, for the first time, the association between spatial social polarization and incarceration among people who inject drugs (PWID) in 19 large U.S. metropolitan statistical areas (MSAs) in 2015.

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Background: Since 2019, multiple HIV outbreaks occurred among people who inject drugs (PWID) in Minnesota. Syringe service programs (SSPs) are evidence-based programs that reduce the spread of HIV. We conducted an assessment of characteristics and HIV risk and prevention among clients of a delivery-based SSP near an HIV outbreak in rural, northern Minnesota.

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Article Synopsis
  • The study investigates the prevalence and experiences of abortion among female sex workers (FSWs) and aims to summarize available data on the topic.
  • A total of 60 studies were analyzed, revealing a lifetime prevalence of at least one induced abortion at 37.7%, with higher rates in countries where abortion is legal compared to those where it is illegal.
  • The findings emphasize a critical need for improved access to contraception and safe abortion services, particularly in countries with restrictive abortion laws, due to higher rates of self-managed abortions among FSWs in those regions.*
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Background: We examined non-fatal drug overdoses during the COVID-19 pandemic among persons who inject drugs (PWID) in New York City (NYC).

Methods: We recruited 275 PWID through respondent driven sampling and staff outreach from Oct. 2021-Sept.

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Background: As the proportion of drug overdose deaths involving fentanyl continues to increase in the US, monitoring exposure to and possible changes in intention to use fentanyl among people who use drugs (PWUD) is of great public health importance. This mixed methods study examines intentionality of fentanyl use among persons who inject drugs (PWID) in New York City during a period of unprecedently high rates of drug overdose mortality.

Methods: Between October 2021 and December 2022, N = 313 PWID were enrolled in a cross-sectional study that included a survey and urine toxicology screening.

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In the context of established and emerging injection drug use epidemics, there is a need to prevent and avert injection drug use. We tested the hypothesis that an individual motivation and skills building counselling, adapted and enhanced from Hunt's Break the Cycle intervention targeting persons currently injecting drugs would lead to reduction in injection initiation-related behaviours among PWID in Tallinn, Estonia. For this quasi-experimental study, pre-post outcome measures included self-reported promoting behaviours (speaking positively about injecting to non-injectors, injecting in front of non-injectors, offering to give a first injection) and injection initiation behaviours (assisting with or giving a first injection) during the previous 6 months.

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Background: To examine COVID-19 vaccination and HIV transmission among persons who inject drugs (PWID) during the COVID-19 pandemic (2020-2022) in New York City (NYC).

Methods: Two hundred and seventy five PWID were recruited from October 2021 to September 2022. A structured questionnaire was used to measure demographics, drug use behaviors, overdose experiences, substance use treatment history, COVID-19 infection, vaccination, and attitudes.

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Objective: To compare COVID-19 stigmatization at two pandemic time points (1) August 2020-during lockdowns and prior to vaccine rollout, and (2) May 2021-during vaccine rollout, when approximately half of U.S. adults were vaccinated.

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Background: People who inject drugs (PWID) are a key population for the prevention and care of HIV infection.

Methods: This scoping review covers recent (post-2010) systematic reviews on engagement of PWID in sequential stages of HIV care from uptake, to achieving viral suppression, and to avoiding AIDS-related mortality.

Results: We found that data on engagement of PWID into antiretroviral therapy (ART) were particularly scarce, but generally indicated very low engagement in ART.

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Background: There has been a significant increase in methamphetamine use among persons who use drugs in Vietnam in the last 5-10 years. We examined the degree to which adherence to antiretroviral therapy (ART) mediates the relationship between recent methamphetamine use and unsuppressed HIV viral load among people who inject drugs (PWID) in Hai Phong, Vietnam.

Methods: We recruited PWID from October 2016-October 2018 and enrolled HIV positive PWID into a cohort, with up to three years of total follow-up.

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Article Synopsis
  • A study in Hai Phong, Vietnam, analyzed gender differences among people who inject drugs (PWID) from 2016 to 2018, recruiting 3146 participants, including 155 female PWID, using respondent-driven-sampling surveys.
  • The average age of female PWID was 36.3 years, and most had low education levels (90.9% without high school) and unemployment (51.3%).
  • While there was no gender difference in HIV and HCV positivity, women showed distinct risk behaviors, such as higher unemployment, involvement in sex work, unstable housing, shorter drug use duration, methamphetamine use, and less access to methadone treatment, indicating a need for targeted interventions.
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People who inject drugs (PWID) are a population exposed to many genotoxicants and with a high prevalence of HCV infection. Direct-acting antiviral (DAA) regimens are now widely used to treat chronic HCV infection. Although side effects to treatment are currently rare, the long-term effects such as suspicions of de novo hepatocellular carcinoma (HCC) occurrence or HCC recurrence and cardiac defects are still up for debate.

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Background: After the emergence of COVID-19, a one-month strict lockdown was imposed in April 2020 in Vietnam, followed by lighter social distancing restrictions over the year. We investigated whether those measures affected people who inject drugs (PWID) in terms of risk behaviors for HIV and HCV and access to prevention and care in the city of Haiphong, a historic hotspot for HIV and drug use.

Methodology: We carried out a 'before-after' study from 2019 to 2020 using respondent-driven sampling method to enroll PWID.

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Many syringe services programs (SSPs) have established trusting, long-term relationships with their clients and are well situated to provide COVID-19 vaccinations. We examined characteristics and practices of SSPs in the United States that reported providing COVID-19 vaccinations to their clients and obstacles to vaccinating people who inject drugs (PWID). We surveyed SSPs in September 2021 to examine COVID-19 vaccination practices through a supplement to the 2020 Dave Purchase Memorial survey.

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Background: We explore injecting risk and HIV incidence among PWID in New York City (NYC), from 2012 to 2019, when incidence was extremely low, <0.1/100 person-years at risk, and during disruption of prevention services due to the COVID-19 pandemic.

Methods: We developed an Agent-Based model (ABM) to simulate sharing injecting equipment and measure HIV incidence in NYC.

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