Outcomes of large-scale syringe exchange in Tallinn, Estonia
Presented by Anneli Uusküla (Estonia).
A. Uusküla1, D. Des Jarlais2, M. Kals1, K. Abel-Ollo3, A. Talu3, K. Rüütel3, I. Sobolev4
1University of Tartu, Tartu, Estonia, 2Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, United States, 3National Institute for Health Development, Tallinn, Estonia, 4NGO Convictus, Tallinn, Estonia
Background: Assess outcomes of expanded syringe exchange in Tallinn, Estonia. There is relatively little research other than pilot studies on syringe exchange in developing/transitional countries. Estonia has experienced a concentrated HIV epidemic among IDUs, with the highest per capita HIV prevalence in Eastern Europe. There are an estimated 10,000 IDUs in Tallinn, the capital and largest city.
Methods: Syringe exchange implementation was monitored with data from the Estonia National Institute for Health Development. Three respondent driven sampling (RDS) interview surveys with biological samples for HIV testing were conducted in Tallinn, N = 350 IDUs in 2005, N = 350 IDUs in 2007, N = 327 IDUs in 2009. HIV incidence among new injectors was estimated (persons injecting or < = 5 years) by assuming
(1) all new injectors were HIV seronegative when they began injecting, and
(2) HIV infections among new injectors occurred at the midpoint between first injection and time of interview.
Results: SEP expanded from 230,000 syringes exchanged in 2005 to 440,000 in 2007 to 770,000 in 2009. In all three surveys, IDUs were predominantly male (80%), ethnic Russians (>80%), and young adults (mean ages 24 to 27 years). HIV prevalence among all subjects stabilized at slightly over 50% (54% in 2005, 55% in 2007, 51% in 2009). Estimated HIV incidence (based on new injectors) decreased significantly in 2009, from 18/100 person-years in 2005 and 21/100 person-years in 2007 to 8/100 person-years in 2009 (p < .01).
Conclusions: Large-scale syringe exchange appears to be quite effective in transitional countries, though further reductions in HIV transmission among IDUs are still required in Estonia. Coverage of 80 or more syringes per IDU per year may be needed before significant reductions in HIV incidence occur.
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