Abstract
ObjectiveWe identified potential geographic “hotspots” for drug-injecting transmission of HIV and hepatitis C virus (HCV) among persons who inject drugs (PWID) in New York City. The HIV epidemic among PWID is currently in an “end of the epidemic” stage, while HCV is in a continuing, high prevalence (> 50%) stage.MethodsWe recruited 910 PWID entering Mount Sinai Beth Israel substance use treatment programs from 2011–2015. Structured interviews and HIV/ HCV testing were conducted. Residential ZIP codes were used as geographic units of analysis. Potential “hotspots” for HIV and HCV transmission were defined as 1) having relatively large numbers of PWID 2) having 2 or more HIV (or HCV) seropositive PWID reporting transmission risk—passing on used syringes to others, and 3) having 2 or more HIV (or HCV) seronegative PWID reporting acquisition risk—injecting with previously used needles/syringes. Hotspots for injecting drug use initiation were defined as ZIP codes with 5 or more persons who began injecting within the previous 6 years.ResultsAmong PWID, 96% injected heroin, 81% male, 34% White, 15% African-American, 47% Latinx, mean age 40 (SD = 10), 7% HIV seropositive, 62% HCV seropositive. Participants resided in 234 ZIP codes. No ZIP codes were identified as potential hotspots due to small numbers of HIV seropositive PWID reporting transmission risk. Four ZIP codes were identified as potential hotspots for HCV transmission. 12 ZIP codes identified as hotspots for injecting drug use initiation.DiscussionFor HIV, the lack of potential hotspots is further validation of widespread effectiveness of efforts to reduce injecting-related HIV transmission. Injecting-related HIV transmission is likely to be a rare, random event. HCV prevention efforts should include focus on potential hotspots for transmission and on hotspots for initiation into injecting drug use. We consider application of methods for the current opioid epidemic in the US.
Highlights
Identifying potential geographic “hotspots” where there is a high likelihood of transmission of infectious diseases is a fundamental task of epidemiology
We identified potential geographic “hotspots” for drug-injecting transmission of HIV and hepatitis C virus (HCV) among persons who inject drugs (PWID) in New York City
We examine potential hotspots for drug injecting related transmission of HIV and hepatitis C virus (HCV) among persons who inject drugs (PWID) in New York City from 2011–2015
Summary
Identifying potential geographic “hotspots” where there is a high likelihood of transmission of infectious diseases is a fundamental task of epidemiology Such hotspots may develop in areas in which there is mixing of infectious and uninfected but susceptible persons. We examine potential hotspots for drug injecting related transmission of HIV and hepatitis C virus (HCV) among persons who inject drugs (PWID) in New York City from 2011–2015. Both viruses can be transmitted through multi-person use (“sharing”) of needles and syringes, while PWID may transmit HIV through high risk sexual behaviors. Identified cases of HIV or HCV infection do not provide any information on the numbers of persons in the potential hotspot who are not yet infected but may be susceptible and at risk for high infection, so that predicting onward transmission can be difficult
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