Rapid Identification and Investigation of an HIV Risk Network Among People Who Inject Drugs –Miami, FL, 2018

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. Keywords People who inject drugs • HIV • Molecular surveillance • Outbreak investigation Resumen La prevención de brotes de VIH entre las personas que se inyectan drogas sigue siendo un desafío para poner fin a la epidemia de VIH en los Estados Unidos. El primer programa legal de servicios de intercambio de jeringas (SSP como se conoce con sus siglas en inglés) en Florida, implementó pruebas rutinarias en 2018 que condujo a la identificación de diez seroconversiones anónimas de VIH. El SSP colaboró con el Departamento de Salud para realizar una investigación epidemiológica. Siete seroconversiones agudas de VIH fueron identificadas y se vincularon a la atención médica (86% en 30 días) y lograron la supresión viral (media 70 días). Seis de los siete individuos están vinculados epidemiológicamente y/o socialmente con al menos otras dos seroconversiones. El análisis de los genotipos del VIH reveló que dos individuos están conectados molecularmente a una distancia genética de 0.5%. Identificamos una red de riesgo con una dinámica de transmisión compleja que no puede explicarse solamente con métodos epidemiológicos o análisis moleculares. Brindando servicios integrales a través del SSP, que incluyan pruebas de rutina, el enlace intensivo y la navegación del paciente, podría ser un modelo eficaz para lograr la supresión viral de las personas que se inyectan drogas.

Interest in linkage to PrEP among people who inject drugs accessing syringe services; Miami, Florida

“…suggested that there was a link between sexual and injection-related HIV risk [20,21]. Several recent reports indicate the growing prevalence of sex work as a component of money-generating strategies among PWID [24,25], and as a risk factor for HIV infection [26][27][28].…”

“…Increasing access to PrEP among PWID is critical at this time when the President has declared a national emergency for the opioid crisis and when there have been reported HIV outbreaks in PWID in several American cities [20,21,37]. Whereas there was desire among 23% of the PWID surveyed to receive PrEP, the lack of any successful linkages suggests an urgent need to both increase knowledge of the effectiveness of PrEP in the PWID community as well as establish low barrier access to PrEP for PWID patients.…”

“…While extensive research has been conducted on the effectiveness of PrEP in men who have sex with men, PrEP has been understudied and underutilized among PWID. More importantly, seen in places such as Scott County, Miami, and Seattle, HIV outbreaks among PWID have been occurring more frequently, and substances being injected have differing HIV risk profiles due to associated injection and sexual behavior [20][21][22]. This current study aims to characterize the difference in PrEP awareness, PrEP knowledge, and interest in PrEP linkage among PWID accessing an SSP.…”

When is an abscess more than an abscess? Syringe services programs and the harm reduction safety-net: a case report

“…A safety-net of care with wrap-around services at an SSP is an effective way to prevent the progression and spread of illnesses among PWID. Routine HIV screening and rapid linkage to care at the IDEA SSP helped to prevent an HIV outbreak in Miami after the identification of ten anonymous HIV seroconversions in 2018 [27]. In the case of this patient, a routine screening for SSTIs at the wound care clinic prevented further complications of his abscess and led to his early HIV diagnosis, initiation of ART, and subsequent rapid viral suppression.…”

Implementation of a medical student-run telemedicine program for medications for opioid use disorder during the COVID-19 pandemic

“…The Infectious Disease Elimination Act (IDEA) syringe services program (SSP) at the University of Miami was established to improve the health outcomes of PWID by providing them with sterile injection equipment, naloxone, and improved access to medical care [ 4 ]. A free student-run clinic in collaboration with the Mitchell Wolfson Sr Department of Community Service (DOCS), operating out of the IDEA SSP, was developed to meet the medical needs of participants and create a space to educate students on the principles of harm reduction.…”