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In the early 2000s, Estonia and Latvia experienced a rapidly growing HIV epidemic among people who inject drugs (PWID), and had, with Russia, the highest diagnosis rates in Europe. Understanding epidemic dynamics in both countries and how responses to HIV impacted them is essential to ending injection-driven epidemics. Statistical modeling, programmatic data collection, and triangulation. Data on newly diagnosed HIV cases were used in a back-calculation model to estimate, for each country, trends in HIV incidence, time to diagnosis, and