Combined Prevention to Reduce Initiation Into Injecting Drug Use
Funded by: National Institute on Drug Abuse
Project dates: March 2015 - January 2023
Principal Investigator: Des Jarlais, Don

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 examined the impact of giving multiple evidence-based interventions on reducing initiation into injecting drug use.  The study was 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 were included, and mathematical modeling was 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
Related Publications
Des Jarlais DC, McKnight C, Weng CA, Feelemyer J, Tross S, Raag M, Org G, Talu A, Uuskula A (2023).
Field testing the “Avoid the Needle” intervention for persons at risk for transitioning to injecting drug use in Tallinn, Estonia and New York City, USA
AIDS and Behavior, 27 (11), 3767-3779. doi: 10.1007/s10461-023-04094-0. PMCID: PMC10227783.

Uuskula A, Raag M, Barnes DM, Tross S, Talu A, Des Jarlais DC (2023).
Adapted “Break the Cycle for Avant Garde” intervention to reduce injection assisting and promoting behaviours in people who inject drugs in Tallinn, Estonia: A pre- post trial
PLoS One, 18 (5), e0266815. doi: 10.1371/journal.pone.0266815. PMCID: PMC10231841.

Uuskula A, Talu A, Rannap J, Barnes DM, Des Jarlais D (2021).
Rapid point-of-care (POC) testing for hepatitis C antibodies in a very high prevalence setting: Persons injecting drugs in Tallinn, Estonia
Harm Reduction Journal, 18 (1), 39. doi: 10.1186/s12954-021-00485-5. PMCID: PMC8015736.

Des Jarlais DC, Arasteh K, Barnes DM, Feelemyer J, Berg H, Raag M, Talu A, Org G, Tross S, Uuskula A (2021).
A multistage process model of how a person who currently injects drugs comes to assist persons who do not inject with their first injections
Frontiers in Sociology, 6, 619560. doi: 10.3389/fsoc.2021.619560. PMCID: PMC8022482.

Uuskula A, Vickerman P, Raag M, Walker J, Paraskevis D, Eritsyan K, Sypsa V, Lioznov D, Avi R, Des Jarlais D (2020).
Presenting a conceptual framework for an HIV prevention and care continuum and assessing the feasibility of empirical measurement in Estonia: A case study
PLoS One, 15 (10), e0240224. doi: 10.1371/journal.pone.0240224. PMCID: PMC7546465.

Uuskula A, Des Jarlais D, Vorobjov S (2019).
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.