Abstract
Prevention of HIV outbreaks among people who inject drugs remains a challenge to ending the HIV epidemic in the United States. The first legal syringe services program (SSP) in Florida implemented routine screening in 2018 leading to the identification of ten anonymous HIV seroconversions. The SSP collaborated with the Department of Health to conduct an epidemiologic investigation. All seven acute HIV seroconversions were linked to care (86% within 30 days) and achieved viral suppression (mean 70 days). Six of the seven individuals are epidemiologically and/or socially linked to at least two other seroconversions. Analysis of the HIV genotypes revealed that two individuals are connected molecularly at 0.5% genetic distance. We identified a risk network with complex transmission dynamics that could not be explained by epidemiological methods or molecular analyses alone. Providing wrap-around services through the SSP, including routine screening, intensive linkage and patient navigation, could be an effective model for achieving viral suppression for people who inject drugs.
Highlights
Facilitated by the increase in opioid addiction and availability of synthetic opioids, injection drug use (IDU) associated HIV outbreaks have occurred across the globe [1]
As homelessness and participation in transactional sex are typically affiliated with people who inject drugs (PWID), disease transmission is compounded among such high-risk individuals [5, 6]
The use of medication-assisted treatment for substance use and dependence, rapid access to antiretroviral therapies (ART) for those living with a diagnosis of HIV, pre-exposure prophylaxis (PrEP), and other harm reduction methods are effective at reducing HIV transmission [9], [10]
Summary
Facilitated by the increase in opioid addiction and availability of synthetic opioids, injection drug use (IDU) associated HIV outbreaks have occurred across the globe [1]. Many opioids are injectable, promoting conditions that expedite the rapid transmission of communicable diseases, including HIV and hepatitis C (HCV), and exacerbating these serious public health epidemics as has been the case in the United States [1, 2]. Absence of interventions and delays in public health action have been connected with the incidence of IDU-associated HIV outbreaks [7]. Considerable evidence has shown that one of the most effective interventions for reducing HIV transmission among PWID is the provision of sterile syringes through syringe services programs (SSPs) [8, 9]. Greatest declines in the number of new HIV diagnoses following IDU-related HIV outbreaks were observed when SSPs were used in combination with other prevention interventions [1, 11]
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