Responding to Outbreaks of Human Immunodeficiency Virus Among Persons Who Inject Drugs—United States, 2016–2019: Perspectives on Recent Experience and Lessons Learned

Abstract

In 2015, a large human immunodeficiency virus (HIV) outbreak occurred among persons who inject drugs (PWID) in Indiana. During 2016–2019, additional outbreaks among PWID occurred across the United States. Based on information disseminated by responding health departments and Centers for Disease Control and Prevention (CDC) involvement, we offer perspectives about characteristics of and public health responses to 6 such outbreaks. Across outbreaks, injection of opioids (including fentanyl) or methamphetamine predominated; many PWID concurrently used opioids and methamphetamine or cocaine. Commonalities included homelessness or unstable housing, previous incarceration, and hepatitis C virus exposure. All outbreaks occurred in metropolitan areas, including some with substantial harm reduction and medical programs targeted to PWID. Health departments experienced challenges locating case patients and contacts, linking and retaining persons in care, building support to strengthen harm-reduction programs, and leveraging resources. Expanding the concept of vulnerability to HIV outbreaks and other lessons learned can be considered for preventing, detecting, and responding to future outbreaks among PWID.

Ingenuity and resiliency of syringe service programs on the front lines of the opioid overdose and COVID-19 crises

“…Syringe service programs (SSPs), which at minimum provide access to and disposal of sterile syringes and injection equipment for people who use drugs (PWUD), were initiated in Australia, Europe, and the United States in response to the hepatitis B and HIV epidemics of the 1980s. 1 , 2 Over the past 4 decades, SSPs have responded creatively and effectively to these ongoing epidemics 3 , 4 and to the emergence of new health crises that have faced PWUD, such as hepatitis C virus (HCV), unsafe drug supply, opioid overdose, endocarditis, and skin and soft tissue infections. 5 – 10 As the novel coronavirus 2019 (COVID-19) pandemic wreaks havoc around the world, SSPs have been forced to pivot and reimagine service delivery to protect the lives of their program participants, volunteers, and staff.…”

Increasing Capacity to Detect Clusters of Rapid HIV Transmission in Varied Populations—United States

“…This analysis also demonstrates that molecular cluster analysis can identify rapid transmission in varied populations, which may change over time. For example, molecular cluster analysis has detected increased rapid transmission among PWID in recent years [11] (11% in 2018-2019 compared with 1% in 2015-2016) [6]. Moreover, such analysis can highlight rapid transmission even when the groups among which transmission is occurring differ from the groups among which new diagnoses most commonly occur, as seen in several states in this analysis.…”

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

“…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.…”