Opioid Use Fueling HIV Transmission in an Urban Setting: An Outbreak of HIV Infection Among People Who Inject Drugs—Massachusetts, 2015–2018

Abstract

Objectives. To describe and control an outbreak of HIV infection among people who inject drugs (PWID). Methods. The investigation included people diagnosed with HIV infection during 2015 to 2018 linked to 2 cities in northeastern Massachusetts epidemiologically or through molecular analysis. Field activities included qualitative interviews regarding service availability and HIV risk behaviors. Results. We identified 129 people meeting the case definition; 116 (90%) reported injection drug use. Molecular surveillance added 36 cases to the outbreak not otherwise linked. The 2 largest molecular groups contained 56 and 23 cases. Most interviewed PWID were homeless. Control measures, including enhanced field epidemiology, syringe services programming, and community outreach, resulted in a significant decline in new HIV diagnoses. Conclusions. We illustrate difficulties with identification and characterization of an outbreak of HIV infection among a population of PWID and the value of an intensive response. Public Health Implications. Responding to and preventing outbreaks requires ongoing surveillance, with timely detection of increases in HIV diagnoses, community partnerships, and coordinated services, all critical to achieving the goal of the national Ending the HIV Epidemic initiative.

A Nationwide Study about the Dispersal Patterns of the Predominant HIV-1 Subtypes A1 and B in Greece: Inference of the Molecular Transmission Clusters

“…Phylogenetic analyses of HIV-1 have several applications in public health, including investigation of transmission dynamics and dispersal and outbreak investigation [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Recently, the Centers for Disease Control and Prevention (CDC) has discussed the benefits of HIV cluster analysis for public health action [ 17 ].…”

“…Recently, the Centers for Disease Control and Prevention (CDC) has discussed the benefits of HIV cluster analysis for public health action [ 17 ]. Investigation on HIV molecular clusters can provide important data about the dispersal patterns of the epidemic, as well as the characteristics of people living with HIV (PLHIV) infected within clusters [ 4 , 5 , 6 , 7 , 8 , 9 , 11 , 12 , 13 , 14 , 15 , 16 , 18 ]. Moreover, by investigating the molecular clusters, we can identify those at higher risk for HIV infection (e.g., the social links of recently infected PLHIV through contact tracing programs) and intervene with targeted strategies to prevent HIV [ 17 ].…”

Network structure and rapid HIV transmission among people who inject drugs: A simulation-based analysis

“…As additional empirical data on injection networks is gathered, we see potential for meta-analyses on the drivers of variability in injection network transitivity values, such that simulated formation of closed triangles may be modeled as an emergent property. While further research is needed to determine how triadic closure could be generated within the current partnering algorithm and framework, there are notably other network-based transmission mechanisms known to have generated injection-driven outbreaks, including high rates of partner turnover due to incarceration ( Alpren et al, 2020 ; Cranston et al, 2019 ). Continued development of network modeling techniques designed to represent characteristics specific to injection networks is needed to understand the range of mechanisms underscoring injection-driven outbreaks.…”

Identification and characterization of tweets related to the 2015 Indiana HIV outbreak: A retrospective infoveillance study

“…In 2016, the U.S. Congress reversed a ban on using federal funds for syringe exchange programs, but many of the rural communities battling the opioid crisis are hesitant to implement comprehensive NEP and other harm reduction services, such as opioid agonist therapy [ 23 ] Hence, persistent barriers of stigma associated with addiction, drug abuse, and HIV status continues to limit access to preventive health and harm reduction services in vulnerable communities, including rural areas. There is also a lack of comprehensive national legislation that specifically addresses the intersection between the opioid, heroin, and HIV risks in the context of the current national opioid crisis [ 23 ] Collectively, obstacles remain to interrupting the dangerous transition from opioid abuse to heroin injection drug use and its associated HIV transmission risks, with new clusters of HIV cases among PWID also emerging in other US states [ 24 , 25 ].…”