HIV outbreaks among people who inject drugs in Europe, North America, and Israel

Jarlais, Don C. Des; Sypsa, Vana; Feelemyer, Jonathan; Abagiu, Adrian; Arendt, Vic; Broz, Dita; Chemtob, Daniel; Seguin-Devaux, Carole; Duwve, Joan; Fitzgerald, Margaret; Goldberg, David J.; Hatzakis, Angelos; Jipa, Raluca; Katchman, Eugene; Keenan, Eamon; Khan, Ibrahim; Konrad, Stephanie; McAuley, Andrew; Skinner, Stuart; Wiessing, Lucas

doi:10.1016/s2352-3018(20)30082-5

Cited by 74 publications

(73 citation statements)

References 47 publications

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“… 13 , 14 , 15 , 16 Homelessness, defined by the Institute of Global Homelessness as lacking access to adequate housing, and unstable housing, typically defined as being without fixed housing, are widely acknowledged as important risk factors for acquisition of HCV or HIV infection, 13 , 14 , 15 , 16 and have been implicated in a series of HIV outbreaks among PWID over the past 10 years. 17 …”

Section: Introductionmentioning

confidence: 99%

Homelessness, unstable housing, and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis

Arum

Fraser

Artenie

et al. 2021

The Lancet Public Health

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137

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Summary Background People who inject drugs (PWID) are at increased risk for HIV and hepatitis C virus (HCV) infection and also have high levels of homelessness and unstable housing. We assessed whether homelessness or unstable housing is associated with an increased risk of HIV or HCV acquisition among PWID compared with PWID who are not homeless or are stably housed. Methods In this systematic review and meta-analysis, we updated an existing database of HIV and HCV incidence studies published between Jan 1, 2000, and June 13, 2017. Using the same strategy as for this existing database, we searched MEDLINE, Embase, and PsycINFO for studies, including conference abstracts, published between June 13, 2017, and Sept 14, 2020, that estimated HIV or HCV incidence, or both, among community-recruited PWID. We only included studies reporting original results without restrictions to study design or language. We contacted authors of studies that reported HIV or HCV incidence, or both, but did not report on an association with homelessness or unstable housing, to request crude data and, where possible, adjusted effect estimates. We extracted effect estimates and pooled data using random-effects meta-analyses to quantify the associations between recent (current or within the past year) homelessness or unstable housing compared with not recent homelessness or unstable housing, and risk of HIV or HCV acquisition. We assessed risk of bias using the Newcastle-Ottawa Scale and between-study heterogeneity using the I 2 statistic and p value for heterogeneity. Findings We identified 14 351 references in our database search, of which 392 were subjected to full-text review alongside 277 studies from our existing database. Of these studies, 55 studies met inclusion criteria. We contacted the authors of 227 studies that reported HIV or HCV incidence in PWID but did not report association with the exposure of interest and obtained 48 unpublished estimates from 21 studies. After removal of duplicate data, we included 37 studies with 70 estimates (26 for HIV; 44 for HCV). Studies originated from 16 countries including in North America, Europe, Australia, east Africa, and Asia. Pooling unadjusted estimates, recent homelessness or unstable housing was associated with an increased risk of acquiring HIV (crude relative risk [cRR] 1·55 [95% CI 1·23–1·95; p=0·0002]; I 2 = 62·7%; n=17) and HCV (1·65 [1·44–1·90; p<0·0001]; I 2 = 44·8%; n=28]) among PWID compared with those who were not homeless or were stably housed. Associations for both HIV and HCV persisted when pooling adjusted estimates (adjusted relative risk for HIV: 1·39 [95% CI 1·06–1·84; p=0·019]; I 2 = 65·5%; n=9; and for HCV: 1·64 [1·43–1·89; p<0·0001]; I 2 = 9·6%; n=14). For risk of HIV acquisition, the association for unstable housing (cRR 1·82 [1·13–2·95; p=0·014...

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Section: Introductionmentioning

confidence: 99%

Homelessness, unstable housing, and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis

Arum

Fraser

Artenie

et al. 2021

The Lancet Public Health

Self Cite

137

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“…Infection prevention measures among PWID are essential to maximize the health of the individual and the public. Without these, there can be clusters of outbreaks, as seen with HCV and HIV recently in many areas around the world, particularly within the United States in Scott County, Indiana, from 2015 to 2016 and in 2 cities in Massachusetts from 2015 to 2018 [ 41 , 42 ]. In these areas, HIV outbreaks among PWID were identified with high rates of HCV co-infection which, in just a few years, blossomed to a few hundred cases in total.…”

Section: Infection Preventionmentioning

confidence: 99%

Opportunities to Offer Harm Reduction to People who Inject Drugs During Infectious Disease Encounters: Narrative Review

Peckham

Young

2020

Open Forum Infectious Diseases

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Increased rates of overdose (OD) and blood-borne infections have been associated with injection drug use (IDU). This increasing overlap between IDU-related infectious diseases (ID) is a byproduct of the opioid OD crisis, especially with the transition to synthetic opioids with faster onset and shorter duration leading to potentially more frequent injections. ID specialists are uniquely positioned to positively impact the opioid OD crisis by capitalizing on opportunistic moments of engagement during clinical encounters with people who inject drugs (PWID). Harm reduction services should therefore be expanded and offered to PWID in ID settings to reduce rates of OD, infection, and hospitalization. Major target areas include: (1) safer injection practices teaching and distribution of materials such as sterile injection supplies, fentanyl test strips, and naloxone; (2) increased screening and access to pre-exposure prophylaxis and post-exposure prophylaxis; and (3) initiation of medications for opioid use disorder. Incorporating these strategies in various treatment settings can expand treatment access, improve patient outcomes, and reduce stigma associated with IDU.

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“…The opioid crisis, which has disproportionately affected rural communities has laid bare the multiple population and environmental factors that underlay vulnerability to these infectious diseases (Keyes et al, 2014 ; Van Handel et al, 2016 ). Individual-level characteristics, such as demographic (e.g., age, race, and disability status) and socioeconomic factors (i.e., poverty status, employment, homelessness, and education) are associated with risk of HIV (Des Jarlais et al, 2020 ; Schalkoff et al, 2020 ). Low healthcare access, including infectious disease screening, prevention measures, such as syringe service programs and substance use disorder treatment can affect the spread of a disease related to injection drug use (Havens et al, 2018 ; Lerner and Fauci, 2019 ; McLuckie et al, 2019 ; Siegler et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

A Vulnerability Assessment for a Future HIV Outbreak Associated With Injection Drug Use in Illinois, 2017–2018

et al. 2021

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The current opioid crisis and the increase in injection drug use (IDU) have led to outbreaks of HIV in communities across the country. These outbreaks have prompted country and statewide examination into identifying factors to determine areas at risk of a future HIV outbreak. Based on methodology used in a prior nationwide county-level analysis by the US Centers for Disease Control and Prevention (CDC), we examined Illinois at the ZIP code level (n = 1,383). Combined acute and chronic hepatitis C virus (HCV) infection among persons <40 years of age was used as an outcome proxy measure for IDU. Local and statewide data sources were used to identify variables that are potentially predictive of high risk for HIV/HCV transmission that fell within three main groups: health outcomes, access/resources, and the social/economic/physical environment. A multivariable negative binomial regression was performed with population as an offset. The vulnerability score for each ZIP code was created using the final regression model that consisted of 11 factors, six risk factors, and five protective factors. ZIP codes identified with the highest vulnerability ranking (top 10%) were distributed across the state yet focused in the rural southern region. The most populous county, Cook County, had only one vulnerable ZIP code. This analysis reveals more areas vulnerable to future outbreaks compared to past national analyses and provides more precise indications of vulnerability at the ZIP code level. The ability to assess the risk at sub-county level allows local jurisdictions to more finely tune surveillance and preventive measures and target activities in these high-risk areas. The final model contained a mix of protective and risk factors revealing a heightened level of complexity underlying the relationship between characteristics that impact HCV risk. Following this analysis, Illinois prioritized recommendations to include increasing access to harm reduction services, specifically sterile syringe services, naloxone access, infectious disease screening and increased linkage to care for HCV and opioid use disorder.

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HIV outbreaks among people who inject drugs in Europe, North America, and Israel

Abstract: During 2011-2016, HIV outbreaks occurred among people who inject drugs (PWID) in

Cited by 74 publications

References 47 publications

Homelessness, unstable housing, and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis

Homelessness, unstable housing, and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis

Opportunities to Offer Harm Reduction to People who Inject Drugs During Infectious Disease Encounters: Narrative Review

A Vulnerability Assessment for a Future HIV Outbreak Associated With Injection Drug Use in Illinois, 2017–2018

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