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

Am J Public Health. 2020 Jan;110(1):37-44. doi: 10.2105/AJPH.2019.305366. Epub 2019 Nov 14.

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.

MeSH terms

  • Adolescent
  • Adult
  • Community Participation
  • Female
  • Genotype
  • HIV Infections / diagnosis
  • HIV Infections / epidemiology*
  • HIV Infections / etiology
  • HIV Infections / prevention & control*
  • Health Services Accessibility
  • Humans
  • Ill-Housed Persons / statistics & numerical data
  • Male
  • Massachusetts / epidemiology
  • Middle Aged
  • Needle-Exchange Programs / organization & administration
  • Opioid-Related Disorders / epidemiology*
  • Polymerase Chain Reaction
  • Public Health Practice*
  • Racial Groups
  • Substance Abuse, Intravenous / epidemiology*
  • Urban Population / statistics & numerical data
  • Young Adult
  • pol Gene Products, Human Immunodeficiency Virus / genetics

Substances

  • pol Gene Products, Human Immunodeficiency Virus