244981 Can non-injecting drug use protect against blood borne viruses among people who inject drugs? Evidence from Tallinn, Estonia and New York City, USA

Monday, October 31, 2011

Kamyar Arasteh, PhD , Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY
Don C. Des Jarlais, PhD , Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY
Sigrid Vorobjov , Estonian Drug Monitoring Centre, National Institute for Health Development, 11619 Tallinn, Estonia
Anneli Uuskula , Department of Public Health, University of Tartu, Tartu 50411, Estonia
David C. Perlman, MD , Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY
Objectives: Many injecting drug users (IDUs) also use drugs through means other than injecting (smoking, snorting, oral). If the non-injecting use substitutes for injecting use, then non-injecting use might protect against infection with blood-borne viruses (BBVs). Methods: In New York City (NYC), 726 IDUs were recruited at a short-term drug detoxification program from 2005-2010. In Tallinn, respondent driven sampling was used to recruit 350 IDUs for a cross-sectional survey in 2007. In both sites, a structured interview was administered and serum samples were collected. Four focus groups were conducted in Tallinn to explore reasons for non-injecting use. Results: In New York, HCV prevalence was 71% among 726 subjects. In a multiple logistic regression analysis, HCV seropositivity was negatively associated with recent intranasal use of heroin (AOR = 0.52, 95% CI 0.330.82) and recent intranasal use of speedball (AOR = 0.41, 95% CI 0.21-0.80). HIV prevalence was 16% and associated with sexual risk but not injecting risk. In Tallinn, HIV prevalence was 59% among 350 subjects. In multivariate analysis, recent non-injecting use of drugs other than alcohol was negatively associated with HIV seropositivity (AOR 0.49; 95%CI 0.25-0.97). HCV testing was not conducted. Focus group members specifically mentioned non-injecting use when clean injection equipment was not available. Conclusions: In two different epidemiologic situations, self reported non-injecting drug use was strongly associated with a lower probability of infection with a BBV. Encouraging intranasal use as an alternative to injection among current IDUs may be a viable strategy for reducing transmission of BBVs.

Learning Areas:
Biostatistics, economics
Epidemiology
Public health or related research
Social and behavioral sciences

Learning Objectives:
Understand the relationship between non-injecting drug use and HCV among IDUs in New York City. Understand the relationship between non-injecting drug use and HIV among IDUs in Tallinn, Estonia. Explain possible strengths and limitations of encouraging non-injecting drug use as a strategy for reducing transmission of blood-borne viruses.

Keywords: HIV Risk Behavior, Intravenous Drug Use

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Dr. Arasteh has investigated the behavioral epidemiology of drug use and HIV for the past 10 years. Much of his research has focused on HIV risk among injection drug users.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.