Response to a Large HIV Outbreak, Cabell County, West Virginia, 2018–2019

Abstract

Introduction: In January 2019, the West Virginia Bureau for Public Health detected increased HIV diagnoses among people who inject drugs in Cabell County. Responding to HIV clusters and outbreaks is 1 of the 4 pillars of the Ending the HIV Epidemic in the U.S. initiative and requires activities from the Diagnose, Treat, and Prevent pillars. This article describes the design and implementation of a comprehensive response, featuring interventions from all pillars.Methods: This study used West Virginia Bureau for Public Health data to identify HIV diagnoses during January 1, 2018−October 9, 2019 among (1) people who inject drugs linked to Cabell County, (2) their sex or injecting partners, or (3) others with an HIV sequence linked to Cabell County people who inject drugs. Surveillance data, including HIV-1 polymerase sequences, were analyzed to estimate the transmission rate and timing of infections using molecular clock phylogenetic analysis. Federal, state, and local partners designed and implemented a comprehensive response during January 2019−October 2019.Results: Of 82 people identified in the outbreak, most were male (60%), were White (91%), and reported unstable housing (80%). In a large molecular cluster containing 56 of 60 (93%) available sequences, 93% of inferred transmissions occurred after January 1, 2018. HIV testing, HIV preexposure prophylaxis, and syringe services were rapidly expanded, leading to improved linkage to HIV care and viral suppression.Conclusions: Evidence of rapid transmission in this outbreak galvanized robust collaboration among federal, state, and local partners, leading to critical improvements in HIV prevention and

Online Partner Seeking and Sexual Behaviors Among Men Who Have Sex With Men From Small and Midsized Towns: Cross-sectional Study

“…In 2019, the Bluegrass Area Development District had the second greatest percentage of HIV diagnoses (19%) in the state of Kentucky [ 47 ], where the majority of cases among men were diagnosed in MSM (67%), persons who inject drugs (PWID; 8%), or MSM and PWID (6%) [ 47 ]. The relevance of the region to HIV research also lies in the region’s geographic proximity to rural Central Appalachia, which is considered highly vulnerable to an HIV outbreak associated with injection drug use [ 48 ], and to 2 recent HIV clusters in Northern Kentucky [ 49 , 50 ] and West Virginia [ 51 ], wherein most cases were among PWID [ 52 ] and PWID with male-to-male sexual contact [ 53 ]. In 2020, Kentucky was named 1 of just 7 rural states targeted by the Ending the HIV Epidemic initiative based on the percentage of new diagnoses occurring in rural areas [ 54 ].…”

A Dynamic Spatial Factor Model to Describe the Opioid Syndemic in Ohio

“…10 However, Ohio has yet to see injection drug-related HIV outbreaks on the scale of neighboring states Indiana, 11,12 Kentucky, 13,14 and West Virginia. 15,16…”

“…10 However, Ohio has yet to see injection drug-related HIV outbreaks on the scale of neighboring states Indiana, 11,12 Kentucky, 13,14 and West Virginia. 15,16 The underlying driver of the syndemic is opioid misuse, but estimating opioid misuse at a population level is challenging because no single data source fully captures the problem. 17,18 Instead, we are able to more easily observe the health outcomes related to misuse, such as overdose death, treatment admissions, and HIV and HCV cases, which form the opioid syndemic and are monitored by ongoing public health surveillance.…”

Notes from the Field: HIV Outbreak During the COVID-19 Pandemic Among Persons Who Inject Drugs — Kanawha County, West Virginia, 2019–2021

“…The number of HIV diagnoses among PWID increased from less than five annually during 2016–2018 to 11 during January–October 2019 ( Figure ). Kanawha County (with an approximate population of 180,000 * ) has high rates of opioid use disorder and overdose deaths, which have been increasing since 2016, † and the county is located near Cabell County, which experienced an HIV outbreak among PWID during 2018–2019 ( 1 , 2 ). In response to the increase in HIV diagnoses among PWID in 2019, WVBPH released a Health Advisory § ; and WVBPH and Kanawha-Charleston Health Department (KCHD) convened an HIV task force, conducted care coordination meetings, received CDC remote assistance to support response activities, and expanded HIV testing and outreach.…”

“…§§§ Among 25 persons with available HIV molecular sequencing data, 19 (76%) were molecularly clustered (i.e., had an HIV sequence that was closely related to the HIV sequence of one or more other persons), indicating recent HIV transmission. Fifteen (79%) persons were in one molecular cluster, unrelated to the cluster identified during the Cabell County outbreak investigation ( 2 ).…”