<i>Notes from the Field:</i> Outbreak of Human Immunodeficiency Virus Infection Among Persons Who Inject Drugs — Cabell County, West Virginia, 2018–2019

Atkins, Amy; McClung, R. Paul; Kilkenny, Michael E.; Bernstein, Kyle; Willenburg, Kara; Edwards, Anita; Lyss, Sheryl; Thomasson, Erica; Panneer, Nivedha; Kirk, Nathan; Watson, Meg; Adkins, Elizabeth; DiNenno, Elizabeth; Hogan, Vicki; Fanfair, Robyn Neblett; Napier, Kathleen; Ridpath, Alison; Perdue, Michelle; Mi, Chen; Surtees, Tamara C.; Handanagić, Senad; Wood, Heather; Kennebrew, Daphne; Cohn, Caitlin; Sami, Samira; Eubank, Scott; Furukawa, Nathan W.; Rose, Bridget; Thompson, Antoine; Spadafora, Lauren J.; Wright, Clive; Balleydier, Shawn; Broussard, Dawn; Reynolds, Pam; Carnes, Neal; Haynes, Nils; Sapiano, Tobey Nelson; McBee, Shannon; Campbell, Ellsworth; Batdorf, Samantha; Scott, Melissa; Boltz, Miracle; Wills, David; Oster, Alexandra M.

doi:10.15585/mmwr.mm6916a2

Cited by 34 publications

(26 citation statements)

References 2 publications

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“…Hamilton County, Ohio has experienced an outbreak of HIV among PWID. Given the growing number of recent HIV outbreaks among PWID reported across the U.S. [8][9][10][11][12][13][37][38][39], collective understanding must shift from awareness that outbreaks can happen to awareness that outbreaks are happening, presumably with some outbreaks currently ongoing but not yet identified and others likely to develop in the future. This analysis reports the contribution of a single, large-volume urban ED screening program to identification of new HIV cases, particularly among PWID, and its contribution to local and state public health department surveillance during the emergence of this regional outbreak.…”

Section: Discussionmentioning

confidence: 99%

“…HIV epidemiology can vary over time, both geographically and by mode of transmission. HIV outbreaks among persons who inject drugs (PWID) have occurred in multiple regions in locations such as Scott County, Indiana [ 8 ], Seattle, Washington [ 9 ]; Northeastern Massachusetts [ 10 ]; Philadelphia, Pennsylvania [ 11 ]; and Cabell County, West Virginia [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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HIV detection by an emergency department HIV screening program during a regional outbreak among people who inject drugs

et al. 2021

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Objective Multiple HIV outbreaks among persons who inject drugs (PWID) have occurred in the US since 2015. Emergency departments (EDs), recognized as essential venues for HIV screening, may play a unique role in identifying undiagnosed HIV among PWID, who frequently present for complications of injection drug use (IDU). Our objective was to describe changes in HIV diagnoses among PWID detected by an ED HIV screening program and estimate the program’s contribution to HIV diagnoses among PWID county-wide during the emergence of a regional HIV outbreak. Methods This was a retrospective study of electronically queried clinical records from an urban, safety-net ED’s HIV screening program and publicly available HIV surveillance data for its surrounding county, Hamilton County, Ohio. Outcomes included the change in number of HIV diagnoses and the ED’s contribution to case identification county-wide, overall and for PWID during 2014–2018. Results During 2014–2018, the annual number of HIV diagnoses made by the ED program increased from 20 to 42 overall, and from 1 to 18 for PWID. We estimated that the ED contributed 18% of HIV diagnoses in the county and 22% of diagnoses among PWID. Conclusions The ED program contributed 1 in 5 new HIV diagnoses among PWID county-wide, further illustrating the importance of ED HIV screening programs in identifying undiagnosed HIV infections. In areas experiencing increasing IDU, HIV screening in EDs can provide an early indication of increasing HIV diagnoses among PWID and can substantially contribute to case-finding during an HIV outbreak.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

HIV detection by an emergency department HIV screening program during a regional outbreak among people who inject drugs

et al. 2021

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“…( 16) These factors are particularly relevant in the context of Cabell County, which is among a growing list of counties experiencing injection-associated HIV outbreaks in recent years. (39)(40)(41)(42) Interventions to promote access to su cient quantity and quality of food for PWID may be complementary to HIV prevention and substance use services in these settings.…”

Section: Discussionmentioning

confidence: 99%

Food Security among People who Inject Drugs in West Virginia

Rouhani¹,

Allen²,

Whaley³

et al. 2021

Preprint

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Background. The substance use epidemic in the United States continues to drive high levels of morbidity and mortality, particularly among people who inject drugs (PWID). Poor access to food co-occurs with illicit drug use and contributes to associated sequelae, such as HIV and diabetes. The objective of this study was to examine factors associated with food security among PWID in a rural Appalachian community. Methods. Cross-sectional surveys were used to collect data in a sample of 420 PWID aged 18 and older Cabell County, West Virginia. Frequency of food access and sociodemographic, structural and drug use characteristics were measured. Food security was defined as reporting ‘never’ going to bed hungry at night in the past six months. Pearson’s χ2 and t-tests were used to identify factors associated with food security. Multivariable logistic regression was employed to estimate adjusted odds of being food secure.Results. Only 71 individuals (17%) reported never going to bed hungry night in the past six months. Adjusted odds of being food secure were higher among PWID who completed high school (aOR 2.94; P=0.010) and usually using drugs alone (aOR 1.97; P=0.025), and lower among PWID who were female (aOR 0.51; P=0.037), experienced homelessness (aOR 0.23, P<0.001), were recently arrested (aOR 0.50 P=0.049), and engaged in receptive sharing of injection equipment (aOR 0.52, P=0.035).Conclusions. We found extremely low levels of food security in a population of PWID in Appalachia who are vulnerable to overdose and infectious disease transmission. Integrated interventions that approach food provision as harm reduction are needed to address the overlapping factors that jeopardize the health and wellbeing of people who inject drugs.

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“…Data are also self-reported and subject to social desirability and recall bias; however, our use of anonymous data collection methods may have reduced the effects of social desirability bias. In addition, our data were collected in 2018, preceding the identification of an injection drug use-associated HIV cluster in Cabell County and the coronavirus pandemic [ 87 ]. As a result, our findings may not reflect the current lived experiences of PWID.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Likelihood of Initiating Others into Injection Drug Use Among People Who Inject Drugs in West Virginia

et al. 2021

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People who inject drugs (PWID) play a critical role in injection-naïve individuals transitioning to injection drug use. We investigated factors associated with future likelihood of initiating injection-naïve individuals using multivariable logistic regression among 418 PWID in rural Appalachia (Cabell County, West Virginia). Less than 10% reported they were likely to initiate someone in the future. Acquiring syringes from a syringe services program was associated with decreased odds of being likely to initiate someone in the future (adjusted odds ratio [aOR] 0.46, 95% CI 0.23, 0.95), while having previously initiated someone into injection drug use was associated with increased odds (aOR 8.65, 95% CI 4.07, 18.41). Among our sample of PWID in Appalachia, a small proportion reported that they would be likely to initiate an injection-naïve individual in the future. Efforts to reduce injection initiation assistance should focus on this subpopulation of PWID who indicate a willingness to engage in this behavior.

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Notes from the Field: Outbreak of Human Immunodeficiency Virus Infection Among Persons Who Inject Drugs — Cabell County, West Virginia, 2018–2019

Cited by 34 publications

References 2 publications

HIV detection by an emergency department HIV screening program during a regional outbreak among people who inject drugs

HIV detection by an emergency department HIV screening program during a regional outbreak among people who inject drugs

Food Security among People who Inject Drugs in West Virginia

Factors Associated with Likelihood of Initiating Others into Injection Drug Use Among People Who Inject Drugs in West Virginia

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