{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T04:49:43Z","timestamp":1754110183035,"version":"3.37.3"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2023,5,31]],"date-time":"2023-05-31T00:00:00Z","timestamp":1685491200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["1DP1DA039542"],"award-info":[{"award-number":["1DP1DA039542"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003510","name":"Estonian Ministry of Education and Research","doi-asserted-by":"crossref","award":["IUT34-17"],"award-info":[{"award-number":["IUT34-17"]}],"id":[{"id":"10.13039\/501100003510","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>In the context of established and emerging injection drug use epidemics, there is a need to prevent and avert injection drug use. We tested the hypothesis that an individual motivation and skills building counselling, adapted and enhanced from Hunt\u2019s Break the Cycle intervention targeting persons currently injecting drugs would lead to reduction in injection initiation-related behaviours among PWID in Tallinn, Estonia. For this quasi-experimental study, pre-post outcome measures included self-reported promoting behaviours (speaking positively about injecting to non-injectors, injecting in front of non-injectors, offering to give a first injection) and injection initiation behaviours (assisting with or giving a first injection) during the previous 6 months. Of 214 PWID recruited, 189 were retained (88.3%) for the follow-up at 6 months. The proportion of those who had injected in front of non-PWID significantly declined from 15.9% to 8.5%, and reporting assisting with 1st injection from 6.4% to 1.06%. Of the current injectors retained in the study, 17.5% reported not injecting drugs at the follow up. The intervention adapted for the use in the setting of high prevalence of HIV and relatively low prevalence of injection assisting, tested proved to be effective and safe.<\/jats:p>","DOI":"10.1371\/journal.pone.0266815","type":"journal-article","created":{"date-parts":[[2023,5,31]],"date-time":"2023-05-31T18:00:07Z","timestamp":1685556007000},"page":"e0266815","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Adapted \u201cBreak the Cycle for Avant Garde\u201d intervention to reduce injection assisting and promoting behaviours in people who inject drugs in Tallinn, Estonia: A pre- post trial"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4036-3856","authenticated-orcid":true,"given":"Anneli","family":"Uusk\u00fcla","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mait","family":"Raag","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David M.","family":"Barnes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Tross","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Talu","family":"Ave","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0157-8168","authenticated-orcid":true,"given":"Don C.","family":"Des Jarlais","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,5,31]]},"reference":[{"issue":"Suppl 5","key":"pone.0266815.ref001","doi-asserted-by":"crossref","first-page":"S213","DOI":"10.1093\/infdis\/jiaa432","article-title":"Infectious Diseases and Injection Drug Use: Public Health Burden and Response","volume":"222","author":"A Levitt","year":"2020","journal-title":"J Infect Dis"},{"key":"pone.0266815.ref002","unstructured":"European Monitoring Centre for Drugs and Drug Addiction (2021), European Drug Report 2021: Trends and Developments, Publications Office of the European Union, Luxembourg."},{"key":"pone.0266815.ref003","doi-asserted-by":"crossref","first-page":"e1192","DOI":"10.1016\/S2214-109X(17)30375-3","article-title":"Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review","volume":"5","author":"L Degenhardt","year":"2017","journal-title":"Lancet Glob Health"},{"issue":"6","key":"pone.0266815.ref004","doi-asserted-by":"crossref","first-page":"e434","DOI":"10.1016\/S2352-3018(20)30082-5","article-title":"HIV outbreaks among people who inject drugs in Europe, North America, and Israel","volume":"7","author":"DC Des Jarlais","year":"2020","journal-title":"Lancet HIV"},{"issue":"Suppl 5","key":"pone.0266815.ref005","doi-asserted-by":"crossref","first-page":"S239","DOI":"10.1093\/infdis\/jiaa112","article-title":"Responding to Outbreaks of Human Immunodeficiency Virus Among Persons Who Inject Drugs\u2014United States, 2016\u20132019: Perspectives on Recent Experience and Lessons Learned","volume":"222","author":"SB Lyss","year":"2020","journal-title":"J Infect Dis"},{"issue":"1","key":"pone.0266815.ref006","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1093\/jurban\/jth083","article-title":"Updating the infection risk reduction hierarchy: preventing transition into injection","volume":"81","author":"D Vlahov","year":"2004","journal-title":"J Urban Health"},{"key":"pone.0266815.ref007","doi-asserted-by":"crossref","first-page":"185","DOI":"10.3109\/09687639809006684","article-title":"Evaluation of a brief intervention to prevent initiation into injecting","volume":"5","author":"N Hunt","year":"1998","journal-title":"Drugs Educ Prev Policy"},{"key":"pone.0266815.ref008","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/j.drugalcdep.2013.08.017","article-title":"Interventions to prevent the initiation of injection drug use: a systematic review","volume":"133","author":"D Werb","year":"2013","journal-title":"Drug Alcohol Depend"},{"key":"pone.0266815.ref009","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.drugalcdep.2014.01.004","article-title":"Interrupting the social processes linked with initiation of injection drug use: results from a pilot study","volume":"137","author":"C Strike","year":"2014","journal-title":"Drug Alcohol Depend"},{"issue":"9","key":"pone.0266815.ref010","doi-asserted-by":"crossref","first-page":"2304","DOI":"10.1007\/s10461-019-02467-y","article-title":"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","volume":"23","author":"D Des Jarlais","year":"2019","journal-title":"AIDS Behav"},{"key":"pone.0266815.ref011","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/1477-7517-4-19","article-title":"My first time: initiation into injecting drug use in Manipur and Nagaland, north-east India","volume":"5","author":"M Kermode","year":"2007","journal-title":"Harm Reduct J"},{"key":"pone.0266815.ref012","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1007\/s10461-013-0693-8","article-title":"Transition to injection drug use: the role of initiators","volume":"18","author":"NK Rotondi","year":"2014","journal-title":"AIDS Behav"},{"volume-title":"Social foundations of thought and action: A social cognitive theory","year":"1986","author":"A. Bandura","key":"pone.0266815.ref013"},{"key":"pone.0266815.ref014","first-page":"6","article-title":"AIDS and the transition to illicit drug injection: results of a randomized trial prevention program","volume":"87","author":"CD Des Jarlais","year":"1992","journal-title":"Br J Addict"},{"key":"pone.0266815.ref015","unstructured":"Gray R. Preventing IDU Initiation Among Drug-Curious Youth: An Attempt to Measurably Reduce IDU Initiation Among Youth in Central Asia. 19th International Harm Reduction Association Conference, 2008, Barcelona, Spain."},{"key":"pone.0266815.ref016","doi-asserted-by":"crossref","first-page":"619560","DOI":"10.3389\/fsoc.2021.619560","article-title":"A Multistage Process Model of How a Person Who Currently Injects Drugs Comes to Assist Persons Who Do not Inject with Their First Injections","volume":"6","author":"DC Des Jarlais","year":"2021","journal-title":"Front Sociol"},{"issue":"10","key":"pone.0266815.ref017","doi-asserted-by":"crossref","first-page":"e0240224","DOI":"10.1371\/journal.pone.0240224","article-title":"Presenting a conceptual framework for an HIV prevention and care continuum and assessing the feasibility of empirical measurement in Estonia: A case study","volume":"15","author":"A Uusk\u00fcla","year":"2020","journal-title":"PLoS One"},{"issue":"2","key":"pone.0266815.ref018","doi-asserted-by":"crossref","first-page":"e0170956","DOI":"10.1371\/journal.pone.0170956","article-title":"HIV prevalence and gender differences among new injection-drug-users in Tallinn, Estonia: A persisting problem in a stable high prevalence epidemic","volume":"12","author":"A Uuskula","year":"2017","journal-title":"PLoS One"},{"key":"pone.0266815.ref019","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/1471-2458-6-54","article-title":"Using standardized methods for research on HIV and injecting drug use in developing\/transitional countries: case study from the WHO Drug Injection Study Phase II","volume":"6","author":"WHO Phase II Drug Injection Collaborative Study Group","year":"2006","journal-title":"BMC Public Health"},{"key":"pone.0266815.ref020","unstructured":"Centers for Disease Control and Prevention, 2012. National HIV Behavioural Surveillance System in Injecting Drug Users\u2014Round 3: Operations Manual. https:\/\/www.cdc.gov\/hiv\/pdf\/statistics\/systems\/nhbs\/nhbs-idu3operationsmanual.pdf (accessed on 28. June 2021)."},{"key":"pone.0266815.ref021","volume-title":"Motivational Inteviewing: Preparing People For Change","author":"WR Miller","year":"2012","edition":"2"},{"issue":"1","key":"pone.0266815.ref022","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s12954-018-0250-x","article-title":"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","volume":"15","author":"DM Barnes","year":"2018","journal-title":"Harm Reduct J"},{"volume-title":"R: A language and environment for statistical computing","year":"2016","author":"R Core Team","key":"pone.0266815.ref023"},{"key":"pone.0266815.ref024","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1198\/jasa.2011.ap09475","article-title":"Improved Inference for Respondent-Driven Sampling Data with Application to HIV Prevalence Estimation","volume":"106","author":"KJ Gile","year":"2011","journal-title":"J Am Stat Assoc"},{"key":"pone.0266815.ref025","doi-asserted-by":"crossref","first-page":"3","DOI":"10.2174\/187447370801150611184218","article-title":"The Misuse of Prescription Opioids: A Threat for Europe?","volume":"8","author":"J van Amsterdam","year":"2015","journal-title":"Curr Drug Abuse Rev"},{"key":"pone.0266815.ref026","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1302\/0301-620X.99B7.BJJ-2016-1350.R1","article-title":"An epidemic of the use, misuse and overdose of opioids and deaths due to overdose, in the United States and Canada: is Europe next?","volume":"99-B","author":"GT Helmerhorst","year":"2017","journal-title":"Bone Joint J"},{"key":"pone.0266815.ref027","doi-asserted-by":"crossref","first-page":"S34","DOI":"10.1016\/j.japh.2016.12.077","article-title":"Hutcheson M, Green TC. Nonprescription naloxone and syringe sales in the midst of opioid overdose and hepatitis C virus epidemics: Massachusetts, 2015","volume":"57","author":"TJ Stopka","year":"2017","journal-title":"J Am Pharm Assoc"},{"key":"pone.0266815.ref028","doi-asserted-by":"crossref","first-page":"ofw157","DOI":"10.1093\/ofid\/ofw157","article-title":"Increasing Infectious Endocarditis Admissions Among Young People Who Inject Drugs","volume":"3","author":"AG Wurcel","year":"2016","journal-title":"Open Forum Infect Dis"},{"key":"pone.0266815.ref029","doi-asserted-by":"crossref","first-page":"102757","DOI":"10.1016\/j.drugpo.2020.102757","article-title":"The fentanyl epidemic in Estonia: factors in its evolution and opportunities for a comprehensive public health response, a scoping review","volume":"81","author":"A Uusk\u00fcla","year":"2020","journal-title":"Int J Drug Policy"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0266815","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,31]],"date-time":"2023-05-31T18:00:31Z","timestamp":1685556031000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0266815"}},"subtitle":[],"editor":[{"given":"Ricky N.","family":"Bluthenthal","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2023,5,31]]},"references-count":29,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,5,31]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0266815","relation":{},"ISSN":["1932-6203"],"issn-type":[{"type":"electronic","value":"1932-6203"}],"subject":[],"published":{"date-parts":[[2023,5,31]]}}}