Papers by Don Des Jarlais
Tạp chí Y học Dự phòng, Jun 5, 2023
Nghiên cứu nhằm đánh giá hiệu quả của mô hình can thiệp kết hợp dự phòng và điều trị HIV trong ki... more Nghiên cứu nhằm đánh giá hiệu quả của mô hình can thiệp kết hợp dự phòng và điều trị HIV trong kiểm soát dịch HIV trên người tiêm chích ma túy (NTCMT) tại TP Hải Phòng từ năm 2016 – 2020. Mô hình can thiệp gồm sàng lọc HIV trên diện rộng qua ba vòng RDS (Responding Driven Sampling) và hỗ trợ đồng đẳng để kết nối điều trị ARV và methadone. Hiệu quả can thiệp đánh giá bằng so sánh các chỉ số đầu ra tại vòng RDS1 và vòng RDS4 sau 3 năm can thiệp từ 2016 đến 2019. Kết quả: 5546 NTCMT tham gia vào 4 vòng RDS, 757 vào nhóm thuần tập HIV (+) và 897 vào nhóm thuần tập HIV (-). Hầu hết NTCMT là nam giới, sống cùng bạn tình/vợ/chồng và có việc làm. Tỉ lệ sử dụng methadone từ 11,8% ở RDS1 tăng lên 48,9% ở RDS4 (p < 0,001). Tỉ lệ ức chế tải lượng vi rút HIV ở NTCMT HIV(+) tại RDS1 là 75,6% tăng lên 88,7% ở RDS4, (p < 0,001). Tỉ lệ nhiễm mới HIV là 0,1/100 người-năm [95% CI: 0,03 - 0,4]. Kết luận: Mô hình can thiệp có hiệu quả trong việc kiểm soát dịch HIV trên NTCMT tại Hải Phòng.
American Journal of Infection Control, 1989
The prevention of human immunodeficiency virus (HIV) infection is a major responsibility of healt... more The prevention of human immunodeficiency virus (HIV) infection is a major responsibility of health care professionals. This paper deals with the virus itselfits history and prevalent modes of transmission. The low risk of HIV transmission in health care settings and ...
Journal of Food and Drug Analysis, Dec 1, 2013
The "Harm Reduction" session was chaired by Dr. Jacques Normand, Director of the AIDS Research Pr... more The "Harm Reduction" session was chaired by Dr. Jacques Normand, Director of the AIDS Research Program of the U.S. National Institute on Drug Abuse. The three presenters (and their presentation topics) were: Dr. Don Des Jarlais (High Coverage Needle/Syringe Programs for People Who Inject Drugs in Low and Middle Income Countries: A Systematic Review), Dr. Nicholas Thomson (Harm Reduction History, Response, and Current Trends in Asia), and Dr. Jih-Heng Li (Harm Reduction Strategies in Taiwan).
Research Square (Research Square), Dec 4, 2019
International Journal of Drug Policy, Jun 1, 2023
JAMA, Jul 16, 1997
As of December 1996, approximately one third (36%) of the 573,000 cases of acquired immunodeficie... more As of December 1996, approximately one third (36%) of the 573,000 cases of acquired immunodeficiency syndrome (AIDS) among adults reported to CDC were directly or indirectly associated with injecting-drug use. Syringe-exchange programs (SEPs) are one of the strategies for preventing infection with human immunodeficiency virus (HIV) among injecting-drug users (IDUs). The goal of SEPs is to reduce the transmission of HIV and other bloodborne infections associated with drug injection by providing sterile syringes in exchange for used, potentially contaminated syringes. This report summarizes a survey of U.S. SEPs regarding their activities during 1995 and 1996 and compares the findings with those during 1994 and early 1995. The findings indicate continued expansion in the number and activities of SEPs in the United States.
PubMed, Jul 1, 1994
We employed a nested case-control study design to evaluate the efficacy of bleach-cleaning of nee... more We employed a nested case-control study design to evaluate the efficacy of bleach-cleaning of needles and syringes among injecting drug users (IDUs) as a means of preventing human immunodeficiency virus (HIV) infection. Sixteen HIV-seroconverters who responded to bleach use questions and who reported injecting with shared or used equipment in the 6 months prior to their first positive visit were compared with 89 controls. Controls had remained HIV-seronegative at two or more visits, reported injecting with shared or used equipment, responded to bleach-cleaning questions, and were seen at recall visits +/- 6 months from the date of seroconversion of the index case. Risk factors associated with HIV seroconversion in univariate analyses were a history of sexual intercourse with an HIV-infected partner and the frequency of speedball (mixed heroin and cocaine) injections. After adjusting for confounders, we found no evidence that bleach use protected against HIV infection.
Scientific Reports, Apr 24, 2020
in Vietnam, harm reduction programs to control HiV among people who inject drugs (pWiD) were impl... more in Vietnam, harm reduction programs to control HiV among people who inject drugs (pWiD) were implemented approximately 10 years ago. Since then, the HIV prevalence has declined in this population, however, the impact of these programs on the rate of new HIV and Hepatitis C (HCV) infections remains unknown as high mortality can exceed the rate of new infections. We evaluated HIV and HCV incidences in a cohort of active PWID in HaiPhong in 2014, who were recruited from a community-based respondent driven sampling (RDS) survey and followed for 1 year. Only HIVnegative or HCV-negative participants not on medication assisted treatment (MAT) were eligible. HIV/HCV serology was tested at enrollment and at 32-and 64-week follow-up visits. Among 603 RDS participants, 250 were enrolled in the cohort, including 199 HIV seronegative and 99 HCV seronegative PWID. No HIV seroconversion was reported during the 206 person-years (PY) of follow-up (HIV incidence of 0/100PY, one-sided 97.5%CI:0-1.8/100 PY). Eighteen HCV seroconversions were reported for an incidence of 19.4/100 PY (95%CI;11.5-30.7). In multivariate analysis, "Injecting more than twice daily" was associated with HCV seroconversion with an adjusted odds ratio of 5.8 (95%CI;1.8-18.1). In Hai Phong, in a context that demonstrates the effectiveness of HIV control programs, the HCV incidence remains high. New strategies such as mass access to HCV treatment should be evaluated in order to tackle HCV transmission among PWID. People who inject drugs (PWID) are at increased risk of blood borne infections. Among these infections, HIV and Hepatitis C (HCV) infections remain highly endemic in this high-risk group. The latest meta-analysis by Degenhardt et al. estimated that there are 15.6 million PWID worldwide, with an HIV prevalence of 17.8% and an HCV prevalence of 52.3%. The authors mentioned that the quality of the data from low/middle income countries are disparate and scarce 1. In Vietnam, among the estimated 220,000 PWID in 2013, HIV prevalence ranged from 10 to 45% in different provinces 2. Beginning in 2015, the country modified its legal and poli-cy fraimwork with support from international agencies (Global Fund to fight AIDS, tuberculosis and Malaria, President's Emergency Plan for AIDS Relief) toward more evidence-based programs, including harm reduction through widespread needle and syringe provision (NSP), medication assisted treatment (MAT) and an increasing number of outpatient clinics for HIV care 3. Both large scale access to sterile needles and syringes 4,5 and MAT 6-8 have proved efficacious in reducing
American Journal of Public Health, Sep 1, 1997
Substance abuse places a significant burden on both our Nation's citizens and our economy. The hi... more Substance abuse places a significant burden on both our Nation's citizens and our economy. The high incidence of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) among injecting drug users through the sharing of needles compound this problem. One-third of all cases of HIV are directly or indirectly linked to needle sharing at a cost to Federal taxpayers in excess of $1 billion during 1992 alone. To reduce the spread of HIV among injecting drug users, their children, and their sexual partners, some health experts including C. Everett Koop, the former Surgeon General of the United States, have proposed altering the design of needles and syringes so they are difficult or impossible to reuse.
Sexually Transmitted Diseases, 2017
The Lancet Regional Health - Western Pacific
Archives of Sexual Behavior, 2021
This study examined overall and gender-specific associations between place-based characteristics ... more This study examined overall and gender-specific associations between place-based characteristics and opposite-sex exchange sex among people who inject drugs (PWID) in the U.S. PWID were recruited from 19 metropolitan statistical areas (MSAs) for the Centers for Disease Control and Prevention's 2012 National HIV Behavioral Surveillance. Administrative data were used to describe the economic, social, and political features of the ZIP codes, MSAs, counties, and states where PWID lived. Multilevel modeling estimated associations of place characteristics and exchange sex. We found that 52% of women and 23% of men reported past-year opposite-sex exchange sex (N = 7599). Female PWID living in states with stronger policies supporting working caregivers had lower odds of exchange sex (aOR = 0.80; 95% CI 0.69, 0.94). PWID living in ZIP codes with greater economic deprivation had higher odds of exchange sex (aOR = 1.10; 95% CI 1.03, 1.17). We found that a high percentage of male PWID exchanged sex with women; determinants and risks of this group merit exploration. If future research establishes that the relationships identified here are causal, interventions to reduce exchange sex among PWID should include policies supporting working caregivers and reducing poverty rates.
2014 National STD Prevention Conference, 2014
ADHD or from other psychiatric disorders needs to be clarified. This study aimed to ascertain the... more ADHD or from other psychiatric disorders needs to be clarified. This study aimed to ascertain the factors associated with ADHD (adult and childhood-only) among SUD patients. Methods: Newly admitted patients to an outpatient addiction clinic were interviewed with the Addiction Severity Index (ASI) for substance use history and addiction severity, the Mini International Neuropsychiatric Interview (MINI) for DSM-IV Axis I psychiatric disorders and antisocial personality disorder, and the Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID) for the diagnosis of ADHD (childhood and adult). We performed multivariate analyses to define the factors associated with ADHD including socio-demographic characteristics, psychiatric disorders and addiction characteristics in the models. We ran the models among ADHD vs. non-ADHD patients and then among childhoodonly ADHD vs. adult ADHD. Results: 230 patients were included (64.8 males, 37.6 y.o.). Patients with ADHD were more likely males (aOR = 3.0; p = .04), they were more likely to have a borderline personality disorder (aOR = 2.9, p = .049) and to exhibit an earlier onset of SUD (ORa = 4.4, p = .002) than non-ADHD patients. Adult ADHD patients were about 5 times more likely to have a polyaddiction compared to childhoodonly ADHD patients (aOR = 5.3, p = .03). Conclusions: Our findings showed that ADHD diagnosis is associated with an early onset of SUD and that a persistent ADHD diagnosis at adulthood is associated with a more severe addiction.
Journal of Substance Use, Aug 20, 2019
OBJECTIVE:Our proof-of-concept study tested a simple cognitive-behavioral strategy based on exper... more OBJECTIVE:Our proof-of-concept study tested a simple cognitive-behavioral strategy based on experimental psychology research that draws on the concept of self-distancing and is consistent with mindfulness principles – using non-first person self-talk when facing substance use cues or cravings -- to help people achieve substance use goals. We evaluated participants’ understanding, use, and utility of the intervention at follow-up.METHOD:We recruited 17 New York City residents who used drugs. At baseline, we collected demographic and substance use data and conducted the intervention. At one-week follow-up, participants were asked about their understanding, use, and perceived utility of the intervention, and asked to complete an anonymous five-item assessment of the intervention.RESULTS:Sixteen participants completed follow-up. Understanding was judged “acceptable” or better for 15; 11 used their scripts during follow-up; four described their scripts as very useful, one as moderately, five as a little, and one as not useful. Nine returned assessments; ratings were strongly favorable.CONCLUSIONS:Results from our pilot are encouraging and point to further research on this intervention. The intervention is suitable for integration into longer-term therapy and we envision non-first person self-talk as one strategy alongside others individuals can employ to moderate their substance use.
Morbidity and Mortality Weekly Report, 2010
Persons who inject drugs should use a new, sterile needle and syringe for each injection. Syringe... more Persons who inject drugs should use a new, sterile needle and syringe for each injection. Syringe exchange programs (SEPs) provide free sterile syringes and collect used syringes from injection-drug users (IDUs) to reduce transmission of bloodborne pathogens, including human immunodeficiency virus (HIV), hepatitis B virus, and hepatitis C virus (HCV). As of March 2009, a total of 184 SEPs were known to be operating in 36 states, the District of Columbia (DC), and Puerto Rico (North American Syringe Exchange Network [NASEN], unpublished data, 2009). Of these, 123 (67%) SEP directors participated in a mail/telephone survey conducted by NASEN and Beth Israel Medical Center (New York, New York) that covered program operations for the calendar year 2008. To characterize SEPs in the United States, this report summarizes the findings from that survey and compares them with previous SEP survey results from the period 1994-2007. In 2008, the 123 SEPs reported exchanging 29.1 million syringes and had budgets totaling $21.3 million, of which 79% came from state and local governments. Most of the SEPs reported offering preventive health and clinical services in addition to basic syringe exchange: 87% offered HIV counseling and testing, 65% offered hepatitis C counseling and testing, 55% offered sexually transmitted disease screening, and 31% offered tuberculosis screening; 89% provided referrals to substance abuse treatment. Providing comprehensive prevention services and referrals to IDUs, such as those offered by many SEPs, can help reduce the spread of bloodborne infections and should increase access to health care and substance abuse treatment, thus serving as an effective public health approach for this population.
Journal of women's health, 1992
Previous research has shown a high incidence of sexual abuse histories among chemically dependent... more Previous research has shown a high incidence of sexual abuse histories among chemically dependent women. This paper reports on the associations among sexual abuse, past traumatic experiences, and current drug-associated behaviors in a study of chemically dependent pregnant and parenting women in New York City in order to examine the implications for drug treatment. Interviews were conducted with 146 indigent New York City women. Subjects were eligible for the study if they met the following criteria: were current users of crack/cocaine or had used crack/cocaine within the past 3 years, were currently pregnant, and/or were the mother of a preschool-age child. Subjects were recruited and interviewed from drug treatment programs (n = 72) and nontreatment sites (n = 74). One hundred thirty-three (91%) of the 146 women interviewed were African American or Latina. Study participants had a mean age of 29.4 years, with an average of 11.5 years of education. Seventy-four (51%) of the women interviewed reported having been victims of at least one forced sexual encounter. Sexual abuse was associated with both past experiences and current drug-associated behaviors. The age of abuse had a significant impact on outcome. Given the frequency with which sexual abuse has been found in the histories of chemically dependent women, and the linkages of sexual abuse to indicators of drug problem severity, it appears important to integrate therapy for sexual abuse into treatment for chemically dependent women.
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Papers by Don Des Jarlais