title: Combined prevention for persons who inject drugs in the HIV epidemic in a transitional country: the case of Tallinn, Estonia.
abstract: 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.
authors: a Department of Public Health , University of Tartu , Tartu , Estonia.
authors: Anneli
authors: A
authors: Uusküla
authors: Don C
authors: DC
authors: Des Jarlais
authors: Mait
authors: M
authors: Raag
authors: Steven D
authors: SD
authors: Pinkerton
authors: Jonathan
authors: J
authors: Feelemyer
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D004957:Estonia / Q000453:epidemiology; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D018671:Needle-Exchange Programs; D011314:Preventive Health Services / Q000458:organization & administration*; D015819:Substance Abuse, Intravenous
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; antiretroviral treatment; opioid substitution treatment; persons who inject drugs; prevention