County-Level Vulnerability Assessment for Rapid Dissemination of HIV or HCV Infections Among Persons Who Inject Drugs, United States

Abstract

Objective A recent HIV outbreak in a rural network of persons who inject drugs (PWID) underscored the intersection of the expanding epidemics of opioid abuse, injection drug use (IDU), and associated increases in hepatitis C virus (HCV) infections. We sought to identify U.S. communities especially vulnerable to rapid spread of IDU-associated HIV, if introduced, and new or continuing high rates of HCV infections. Design We conducted a multi-step analysis to identify which indicator variables were highly associated with IDU. We then used these indicator values to calculate vulnerability scores for each county to identify which were most vulnerable. Methods We used confirmed cases of acute HCV infection reported to the National Notifiable Disease Surveillance System, 2012–2013, as a proxy outcome for IDU, and 15 county-level indicators available nationally in Poisson regression models to identify indicators associated with higher county acute HCV infection rates. Using these indicators, we calculated composite index scores to rank each county’s vulnerability. Results A parsimonious set of six indicators were associated with acute HCV infection rates (proxy for IDU): drug overdose deaths, prescription opioid sales, per capita income, white, non-Hispanic race/ethnicity, unemployment, and buprenorphine prescribing potential by waiver. Based on these indicators, we identified 220 counties in 26 states within the 95th percentile of most vulnerable. Conclusions Our analysis highlights U.S. counties potentially vulnerable to HIV and HCV infections among PWID in the context of the national opioid epidemic. State and local health departments will need to further explore vulnerability and target interventions to prevent transmission.

Vital Signs: Trends in HIV Diagnoses, Risk Behaviors, and Prevention Among Persons Who Inject Drugs — United States

“…Recent changes in federal law † † † † † afford an opportunity to improve provision of comprehensive prevention services to all PWID through SSPs. It is important for jurisdictions to understand patterns of substance use in their communities, assess their SSP needs, and ensure services are provided to PWID (13). The findings in this report are subject to at least three limitations.…”

“…For the first time, in 2014, a larger number of white PWID received an HIV Further, although white PWID in 22 cities reported increases in receipt of sterile syringes from SSPs similar to increases reported among blacks and Hispanics, they were least likely to receive all their syringes from sterile sources and most likely to have shared syringes. Rural areas, which are predominately white, include some of the most vulnerable populations for injection drug use and injection drug use-related HIV outbreaks and might have the greatest unmet need for risk reduction services provided by SSPs (9,13,14).…”

HIV and viral hepatitis coinfection analysis using surveillance data from 15 US states and two cities

“…Assessing coinfection trends provides important information about clinical care needs (e.g., linkage to care and treatment) and for public health intervention (e.g., preexposure prophylaxis or syringe service programmes). Using surveillance data to assess coinfections is crucial for monitoring health status and measuring benchmarks to eliminate HIV and viral hepatitis infections [28, 34, 36]. Our analysis demonstrated that a standardized approach for assessing coinfections can be applied to surveillance data from different systems and jurisdictions.…”

“…However, limitations of the surveillance systems might have affected the results of this analysis and resulted in an underestimation of coinfections. The ultimate goal of identification is early intervention to decrease morbidity and mortality associated with these conditions, improve clinical outcomes, and limit viral transmission to susceptible persons [28, 37]. …”

Illicit Drug Use, Illicit Drug Use Disorders, and Drug Overdose Deaths in Metropolitan and Nonmetropolitan Areas—United States

“…For example, an investigation of HIV infections linked to the injection of prescription opioids found that the majority of the counties at high risk for rapid dissemination of hepatitis C virus or HIV were in rural areas (26). Access to substance abuse treatment services is more limited in rural areas (27) and strengthening the health care delivery system while improving the integration of primary, specialty, and substance abuse services can provide the nexus of care needed to reduce drug misuse (28)(29)(30)(31). Specific interventions to address overdose deaths in rural areas have been discussed previously (25) and might include actions such as expanding the types of emergency medical service providers that can administer naloxone to reverse a drug overdose.…”