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Address correspondence to: R. Paul McClung, MD, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, US 8-2, Atlanta GA 30333.
Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GeorgiaU.S. Public Health Service Commissioned Corps, Atlanta, Georgia
Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia
West Virginia Department of Health & Human Resources, West Virginia Bureau for Public Health, Charleston, West VirginiaDivision of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia
Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GeorgiaU.S. Public Health Service Commissioned Corps, Atlanta, Georgia
Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia
Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia
Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia
Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia
Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia
Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GeorgiaU.S. Public Health Service Commissioned Corps, Atlanta, Georgia
Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GeorgiaU.S. Public Health Service Commissioned Corps, Atlanta, Georgia
In January 2019, the West Virginia Bureau for Public Health detected increased HIV diagnoses among people who inject drugs in Cabell County. Responding to HIV clusters and outbreaks is 1 of the 4 pillars of the Ending the HIV Epidemic in the U.S. initiative and requires activities from the Diagnose, Treat, and Prevent pillars. This article describes the design and implementation of a comprehensive response, featuring interventions from all pillars.
Methods
This study used West Virginia Bureau for Public Health data to identify HIV diagnoses during January 1, 2018–October 9, 2019 among (1) people who inject drugs linked to Cabell County, (2) their sex or injecting partners, or (3) others with an HIV sequence linked to Cabell County people who inject drugs. Surveillance data, including HIV-1 polymerase sequences, were analyzed to estimate the transmission rate and timing of infections using molecular clock phylogenetic analysis. Federal, state, and local partners designed and implemented a comprehensive response during January 2019–October 2019.
Results
Of 82 people identified in the outbreak, most were male (60%), were White (91%), and reported unstable housing (80%). In a large molecular cluster containing 56 of 60 (93%) available sequences, 93% of inferred transmissions occurred after January 1, 2018. HIV testing, HIV pre-exposure prophylaxis, and syringe services were rapidly expanded, leading to improved linkage to HIV care and viral suppression.
Conclusions
Evidence of rapid transmission in this outbreak galvanized robust collaboration among federal, state, and local partners, leading to critical improvements in HIV prevention and care services. HIV outbreak response requires increased coordination and creativity to improve service delivery to people affected by rapid HIV transmission.
INTRODUCTION
Cabell County, West Virginia, a medium metropolitan area bordering Kentucky and Ohio, has been severely affected by the U.S. opioid crisis; fentanyl and methamphetamine use are common among people who inject drugs (PWID) in the county,
Cabell County has strong public health and healthcare infrastructure, including the local health department (Cabell–Huntington Health Department [CHHD]), a large academic medical center (Marshall Health), and a network of community health centers (The Valley Health System [VHS]). Treatment for opioid use disorder is available through multiple healthcare systems and through community organizations.
In January 2019, the West Virginia Bureau for Public Health (BPH) detected increased HIV diagnoses among PWID in Cabell County, with 15 since January 2018 (9 during October 2018–December 2018), much higher than the previous average of 2 diagnoses per year. Partner services interviews identified common challenges affecting PWID, including homelessness and unstable housing, limited knowledge about HIV, and sharing of injection equipment. Analysis of HIV-1 polymerase sequences identified a cluster of linked sequences indicative of rapid transmission, further heightening concern. BPH and CHHD requested assistance from CDC with investigation and response efforts.
The federal Ending the HIV Epidemic (EHE) in the U.S. initiative features 4 pillars of HIV prevention and care activities, including (1) Diagnose all people with HIV as early as possible; (2) Treat people with HIV rapidly and effectively to reach sustained viral suppression; (3) Prevent new HIV transmissions using proven interventions, including pre-exposure prophylaxis (PrEP) and syringe services programs (SSPs); and (4) Respond quickly to potential HIV outbreaks to get prevention and treatment services to people who need them.
Response to HIV outbreaks requires timely delivery of effective interventions from the other 3 pillars to communities experiencing rapid transmission; this paper uses the EHE pillars as a framework to describe the response efforts and service gaps identified and addressed.
METHODS
Response Planning
Federal, state, and local partners collaborated to implement a comprehensive response. BPH, CHHD, and CDC staff met by teleconference to review commonalities among cases, HIV care status, and availability of HIV prevention and care services. CDC and the Health Resources and Services Administration (HRSA) conducted site visits to accelerate planning and provided remote technical assistance throughout the response. Input from PWID and community partners informed response interventions and swift programmatic improvements to address gaps in Cabell County HIV prevention and care services, including interventions corresponding to the Respond, Diagnose, Treat, and Prevent EHE pillars.
Case Definition and Data Analysis
The outbreak case definition included HIV diagnoses during January 1, 2018–October 9, 2019 among (1) PWID linked to Cabell County (including people with HIV residing in or experiencing homelessness in Cabell County at the time of diagnosis, diagnosed at a facility in Cabell County, or who accessed syringe services in Cabell County), (2) their sex or injecting partners, or (3) others with an HIV sequence linked to Cabell County PWID.
Demographic, partner services, and clinical care data (including HIV-1 polymerase sequences from drug resistance testing) reported to the BPH HIV surveillance program through December 2020 were analyzed. Pairwise sequence analysis was conducted using HIV-TRACE (TRAnsmission Cluster Engine)
Linked sequences were analyzed using molecular clock phylogenetic analysis with Bayesian Evolutionary Analysis Sampling Trees (BEAST), version 1.82, to estimate transmission rate and infer the timing of infections.
HIV testing data from EvaluationWeb (for public health–funded HIV testing) and from healthcare facility laboratories (for Marshall Health and VHS) and CHHD SSP utilization data were summarized.
RESULTS
Epidemiology of the Outbreak
The outbreak included 82 people. Most were male (60%), were non-Hispanic White (91%), reported injection drug use (99%), and had previous reactive hepatitis C antibody tests (88%); many reported current homelessness or unstable housing (80%) or sharing injection equipment (77%). Some (43%) reported previous incarceration. Most female (58%) and some male (14%) individuals reported exchanging drugs or money for sex; condom-less sex was commonly reported by both male (82%) and female (82%) individuals. HIV sequences were available for 60 of 82 (73%) people. In a single molecular cluster containing 56 (93%) sequences, 93% of inferred transmissions occurred after January 1, 2018, and 67% occurred after January 1, 2019 (Figure 1). The transmission rate in the molecular cluster during January 1, 2018–October 9, 2019 was 134 infections per 100 person-years. Among 81 PWID in the outbreak, the median CD4 count at HIV diagnosis (576 cells/µL) and the median initial HIV-1 viral load (111,000 copies/mL) were higher than the median among Cabell County PWID with HIV diagnosed during 2013–2017 (474 cells/μL and 41,475 copies/mL, respectively) (Table 1).
Figure 1Molecular clock phylogenetic tree for a large molecular cluster from an HIV outbreak in Cabell County, West Virginia, 2018–2019.
Note: Node ages were estimated with Bayesian Evolutionary Analysis Sampling Trees (BEAST), version 1.8.2, using a narrow fixed prior strict molecular clock and 2 independent runs. Nodes represent simulated transmission events; gray nodes have estimated transmission dates before January 1, 2019, and black nodes have estimated transmission dates after January 1, 2019.
Among persons assumed to be alive as of December 31, 2020, including n=11 (2013–2017) and n=75 (January 2018–October 9, 2019). PWID, people who inject drugs.
n (%)
Suppressed (<200 copies/mL)
7 (64)
38 (51)
Unsuppressed (≥200 copies/mL)
1 (9)
23 (31)
Not measured in 2020
3 (27)
14 (19)
Note: PWID with HIV diagnosed before and during the outbreak includes persons with an HIV transmission risk factor of injection drug use or male-to-male sexual contact and injection drug use who had a Cabell County residence at the time of HIV diagnosis, whose HIV infection was diagnosed in a Cabell County facility, or who were epidemiologically or molecularly linked to the outbreak. All data were reported to the West Virginia HIV surveillance program by December 31, 2020. Stage 1, CD4 cell count ≥500 or CD4 percentage ≥26; Stage 2, CD4 cell count of 200–499 or CD4 percentage of 14–25; Stage 3, opportunistic infection or CD4 cell count <200 or CD4 percentage <14.
a Among persons with a result measured ≤90 days after HIV diagnosis.
b Excluding 2 persons with HIV diagnosed during 2019 without evidence of HIV medical care after diagnosis.
c Among persons who achieved viral suppression ≤365 days after HIV diagnosis.
d Among persons assumed to be alive as of December 31, 2020, including n=11 (2013–2017) and n=75 (January 2018–October 9, 2019).PWID, people who inject drugs.
The team (i.e., the combined federal, state, and local response team) implemented a robust, multidisciplinary response. Response activities, organized by the EHE initiative pillar (Figure 2), are described in this section. To accelerate implementation, BPH requested federal staff support to augment state and local efforts. During April 2019–October 2019, a total of 34 CDC and HRSA staff deployed to West Virginia. During April–June, 7–14 staff were deployed at a time, including 3–5 disease intervention specialists (DIS); 2–3 DIS continued supporting BPH partner services during June 2019–October 2019. A total of 35 additional federal staff supported the response remotely. By September 2019, monthly HIV diagnoses were <3, and on October 9, 2019, BPH transitioned to broader efforts to monitor HIV transmission and improve HIV outbreak preparedness statewide.
West Virginia Department of Health & Human Resources, Bureau for Public Health Health advisory #162 Human immunodeficiency virus (HIV) infections among people who inject drugs – additional area seeing increase, others vulnerable.
West Virginia Department of Health & Human Resources, Bureau for Public Health,
Charleston, WVOctober 9, 2019
BPH, West Virginia Bureau for Public Health; CHH, Cabell- Huntington Hospital; CHHD, Cabell–Huntington Health Department; ED, emergency department; EHE, Ending the HIV Epidemic; MOUD, medication for opioid use disorder; PrEP, pre-exposure prophylaxis; SNS, social network strategy; SSP, syringe services program; VHS, The Valley Health System.
Summarize and monitor epidemiologic data in near real time. Automated, real-time outbreak reports were developed to summarize demographic, behavioral, and HIV care information needed to prioritize and monitor response activities. Data were protected by CDC and BPH security and confidentiality policies, and limited aggregate data were shared with CHHD through a data-sharing agreement. BPH engaged local healthcare providers to promote prompt reporting of HIV diagnoses and commercial laboratories to increase laboratory reporting of HIV sequences from monthly to weekly.
Identify and engage community stakeholders. The team identified and met with organizations providing services for Cabell County PWID to discuss the gaps and opportunities for HIV prevention and care; held a healthcare provider forum; and met with healthcare facilities to discuss HIV testing, HIV care, and PrEP. BPH released 2 health advisories.
West Virginia Department of Health & Human Resources, Bureau for Public Health Health advisory #155 increase in new HIV infections among persons who inject drugs.
West Virginia Department of Health & Human Resources, Bureau for Public Health,
Charleston, WVMarch 22, 2019
West Virginia Department of Health & Human Resources, Bureau for Public Health Health advisory #158 recommendations for routine HIV testing and available resources for healthcare providers.
West Virginia Department of Health & Human Resources, Bureau for Public Health,
Charleston, WVApril 29, 2019
The team collaborated with community-based organizations (CBOs) serving PWID during HIV outreach activities and provided HIV education to CBO staff. To convey the urgency of the response and build support for response activities, CHHD leadership engaged local civic leaders and held 2 public forums. The team also talked with PWID to understand their experiences and needs and conducted qualitative interviews with PWID engaged in sex work to understand their unique barriers to HIV prevention and care. These insights informed response activities and a comprehensive, audience-specific communication plan, including key messages, health communication materials, and a new BPH outbreak website.
Human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS). West Virginia Department of Health & Human Resources, Office of Epidemiology & Prevention Services. https://oeps.wv.gov/hiv-aids/. Accessed January 1, 2021.
Coordinate inter-agency and intra-agency response efforts. The team coordinated response efforts using incident command principles from the National Incident Management System.
BPH and CHHD instituted unified command, and CDC implemented an Incident Management System to coordinate federal support. Response interventions were designed and implemented by multiagency teams led by state and local staff.
Diagnose
Enhance partner services capacity. BPH partner services outreach faced challenges, including staff vacancies, limited experience working with PWID, and no electronic case management system. During April 2019–October 2019, CDC DIS assisted with partner services interviews, coordinating field activities, and mentorship. During this period, BPH and CDC DIS interviewed 49 index cases from the outbreak and initiated follow-up with 303 sexual or needle-sharing partners and 225 social contacts of index cases and their partners; 9 HIV diagnoses were identified from 303 tests (3.0% positivity). DIS also contributed to outreach testing and linkage to HIV care.
Expand public health–funded HIV testing, including outreach testing and rapid testing. Before the outbreak, CDC and BPH funding supported HIV testing in Cabell County through CHHD (sexually transmitted disease clinic and SSP), DIS, and 1–3 annual community testing events. To expand HIV testing access, the team conducted 4 large testing events and trained 22 staff to conduct HIV rapid testing using an updated algorithm. Insight from partner services interviews informed >30 small venue–based and impromptu testing events at residences, CBOs (including social services organizations serving people experiencing homelessness), jails, and churches; health communication materials encouraged people to seek HIV testing at CHHD. CHHD staff provided testing to sober-living housing residents and increased the frequency of opt-out HIV testing for CHHD SSP clients from semiannual to quarterly. Consequently, funded HIV testing in Cabell County increased from 139 tests per month in 2018 to 272 tests per month during January 2019–October 2019; most HIV diagnoses in the outbreak (43 of 82, 52%) were identified through funded tests (4,387 total tests, 1.0% positivity).
Expand HIV testing in clinical settings frequented by people who inject drugs. The team met with area healthcare facilities to increase HIV testing during healthcare encounters with PWID and provide guidance on HIV testing algorithms. VHS community health centers expanded opt-out testing in primary care and increased routine testing and retesting in substance use disorder (SUD) treatment programs; a FOCUS grant from Gilead Sciences enabled additional testing expansion. HIV testing in VHS facilities in Cabell County increased by 173% from 2018 (1,603 tests) to 2019 (4,376 tests). Cabell‒Huntington Hospital implemented a nurse-driven, risk-based HIV testing protocol in the emergency department using electronic medical record prompts and tested all PWID admitted to the hospital. HIV testing at Cabell‒Huntington Hospital increased by 340% from 47 tests (2 reactive, 4.3% positivity) in 2018 to 207 tests (9 reactive, 4.3% positivity) in 2019. Of HIV diagnoses in the outbreak, 33 of 82 (40%) occurred in healthcare facilities.
Treat
Improve linkage to HIV care. To decrease delays in linkage to HIV care, the Marshall Health Infectious Disease Clinic established a same-day standing HIV care appointment and began rapid initiation of antiretroviral therapy (ART). Coordination among Marshall Health, DIS, the HRSA Ryan White HIV/AIDS Program, area healthcare facilities, and CBOs was intensified to ensure that people with HIV were swiftly contacted, counseled, and supported to attend their first HIV care appointment. Because of these efforts, linkage of PWID to HIV care within 30 days of diagnosis increased from 33% (2013–2017) to 65% (PWID diagnosed during the outbreak) (Table 1); the median time to linkage to care was reduced from 47 days to 8 days. To strengthen future activities, BPH established a new linkage to care coordinator in Cabell County.
Improve retention in HIV care and viral suppression. To improve retention in care and viral suppression and address social and structural barriers to care, the Marshall Health Infectious Disease Clinic convened a biweekly case conference attended by clinic providers, social workers, nurses, the HRSA Ryan White HIV/AIDS Program case manager, DIS, and staff from the BPH HIV surveillance program, CHHD, and a local CBO. Staff discussed patient updates, including missed appointments and unfilled prescriptions, and developed individualized care plans to address housing, transportation, social support, behavioral health, and other needs. To improve ART adherence, CHHD established medication storage and automated ART prescription refills for SSP clients, and Marshall Health began providing HIV care at the SSP weekly. To improve ART adherence and HIV viral suppression, a Marshall Health provider became licensed to prescribe buprenorphine to patients with HIV with opioid use disorder,
collaborating with a VHS SUD clinic for long-term follow-up. Access to transportation for medical appointments was improved through a contract with a ride-sharing service. From June 2019 to December 2019, viral suppression among people in the outbreak improved from 16% (9 of 56) to 43% (34 of 80). The median time to viral suppression decreased by 40% from 221 days among PWID with HIV diagnosed during 2013–2017 to 132 days among PWID in the outbreak (Table 1). As of December 2020, 81% of PWID in the outbreak had a viral load performed in 2020, a total of 67% had ever achieved viral suppression, and 51% were suppressed on their most recent 2020 viral load.
Prevent
Expand syringe services program access, enrollment, and use. CHHD has operated a large, comprehensive SSP since 2015 with integrated HIV testing, referral to SUD treatment, and a naloxone distribution program. Because of pressure from community members who attributed crime and syringe litter to the SSP, beginning in May 2018, CHHD limited services to Cabell County residents, required near 1:1 exchange, discontinued secondary exchange, and limited the maximum number of syringes dispensed to 40 per visit. As a result, SSP visits fell from 1,553 in January 2018 to a monthly average of 510 during July 2018–December 2018, and syringes distributed fell from 62,120 to 17,681 per month. In response to the outbreak, CHHD re-expanded SSP access for partners and social contacts of PWID affected by the outbreak, hired additional SSP staff, and implemented a social network strategy during May 2019–August 2019 using peer-to-peer recruitment to enroll PWID in the SSP and provide HIV testing and PrEP. Through these efforts, SSP enrollment increased from 366 people (February 2019) to 887 people (November 2019), including >50 people with HIV; SSP visits and syringes distributed increased to 1,067 visits per month and 36,623 syringes per month during July 2019–December 2019. During 2018–2019, SSP staff made 824 referrals to SUD treatment.
Expand access to pre-exposure prophylaxis. Access to and awareness of PrEP, which is effective at reducing HIV transmission among PWID,
Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial.
The team delivered PrEP training to >100 staff members at VHS and Marshall Health, assisted with the integration of PrEP into SUD treatment in VHS facilities, and established a PrEP clinic at CHHD. PWID were referred for PrEP by DIS, the CHHD SSP, HIV testing event staff, and new health education materials. During the response, the number of sites providing PrEP in Cabell County increased from 2 to 15.
; the 82 HIV diagnoses over approximately 21 months represent a >20-fold increase above the previous baseline of 2 PWID diagnoses per year. Nearly all HIV transmission occurred during an 18-month period (January 2018–June 2019), including many transmission events after response activities began, highlighting the importance of rapid response to interrupt transmission and deliver critical HIV prevention and care services.
This multifaceted response depended on several crucial components. First, early discussions with PWID, healthcare providers, and CBO staff were essential for identifying and prioritizing service gaps and intervention opportunities; strong local leadership facilitated context-appropriate interventions on the basis of these insights. Second, enhanced care coordination at Marshall Health transformed HIV care for PWID into a personalized, multidisciplinary process; this approach—featuring elements of data to care
Improvements in HIV care engagement and viral load suppression following enrollment in a comprehensive HIV care coordination program [published correction appears in Clin Infect Dis. 2015;60(12):1879].
—shows great promise for future HIV outbreak responses. Third, expanded delivery of sterile syringes, HIV testing, and other services through the CHHD SSP was paramount; rapid expansion of and improvements in SSP services are essential to responding to and preventing HIV outbreaks among PWID.
Responding to outbreaks of human immunodeficiency virus among persons who inject drugs-United Sates, 2016-2019: perspectives on recent experience and lessons learned.
Fourth, robust partner services accelerated case finding, promoted strong on-the-ground coordination, and provided invaluable insight for response planning. Health departments preparing for future outbreaks should develop the flexibility to expand DIS capacity, extend outreach to social contacts of outbreak cases and their partners, and integrate DIS into the response planning process. Finally, strong coordination between CDC, HRSA, BPH, and CHHD using the principles of incident command was essential for communicating the needs and progress of implementing this complex response.
Although this response was large and resource intensive, the approach reflects the key principles of the Respond pillar relevant to clusters and outbreaks of all types and sizes. First, the team identified specific gaps in HIV prevention and care services and developed response interventions and programmatic changes to address them; many of these interventions can be scaled to match the response needs and available resources. Second, the team engaged community partners throughout the response and empowered local leadership to convene stakeholders, navigate community dynamics, and communicate key messages. Third, this response required flexibility in applying state and federal funding; timely allocation of new and existing funds enabled expanded HIV testing, health communication, and staff support. Although West Virginia is not currently funded for EHE, this response shows that these principles can be applied in all jurisdictions.
This response involved navigating numerous challenges. Although an SSP was operating before the outbreak, restrictions adopted in early 2018 severely limited its ability to prevent or respond to increased HIV transmission among PWID; despite rapid re-expansion during the response, syringe distribution did not reach previous levels, and ongoing work is required to continue improving access, expanding use, and building community support. Integrating, analyzing, reporting, and monitoring crucial outbreak data from disparate surveillance, partner services, and other data systems was slow and labor intensive, underscoring the need to modernize and integrate HIV data systems and develop standard analysis and reporting tools for future outbreaks. Despite initial successes, HIV transmission remains above the previous Cabell County baseline. Moreover, work is needed to reduce stigma and marginalization, address housing instability and limited PrEP persistence,
retest and retain PWID in HIV care, improve viral suppression, and improve linkage to hepatitis C testing and treatment. Success in these areas will require creative, person-centered approaches to directly addressing the numerous social and structural barriers faced by PWID,
Responding to outbreaks of human immunodeficiency virus among persons who inject drugs-United Sates, 2016-2019: perspectives on recent experience and lessons learned.
especially those experiencing homelessness. Additional challenges include inadequate public health staff capacity and the coronavirus disease 2019 (COVID-19) pandemic, which has disrupted service delivery for PWID
and diverted limited public health response resources. Similar challenges have been noted in previous HIV outbreaks among PWID, which have become more numerous in recent years and have required sustained investment and innovation to control.
Responding to outbreaks of human immunodeficiency virus among persons who inject drugs-United Sates, 2016-2019: perspectives on recent experience and lessons learned.
Programmatic improvements achieved during this response can now benefit future HIV prevention and care in Cabell County. The response improved early diagnosis of HIV by expanding testing capacity in diverse settings, enhanced linkage to HIV care and viral suppression through improved care coordination, and expanded access to PrEP and syringe services. State and local capacity grew through training, experience, and investment in new staff and can now be extended further through partnership-building efforts with local health departments and community partners statewide. Using rapid interventions and timely programmatic changes to address gaps in HIV prevention and care services, HIV outbreak response can accelerate progress toward ending the HIV epidemic in the U.S.
ACKNOWLEDGMENTS
The authors would like to thank staff from the West Virginia Bureau for Public Health, Cabell–Huntington Health Department, and numerous local organizations for their contributions to this response.
No financial disclosures were reported by the authors of this paper.
SUPPLEMENT NOTE
This article is part of a supplement entitled The Evidence Base for Initial Intervention Strategies for Ending the HIV Epidemic in the U.S., which is sponsored by the U.S. Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services (HHS). The findings and conclusions in this article are those of the author(s) and do not necessarily represent the official position of CDC or HHS.
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Human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS). West Virginia Department of Health & Human Resources, Office of Epidemiology & Prevention Services. https://oeps.wv.gov/hiv-aids/. Accessed January 1, 2021.
Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial.
Improvements in HIV care engagement and viral load suppression following enrollment in a comprehensive HIV care coordination program [published correction appears in Clin Infect Dis. 2015;60(12):1879].
Responding to outbreaks of human immunodeficiency virus among persons who inject drugs-United Sates, 2016-2019: perspectives on recent experience and lessons learned.
This article is part of a supplement entitled The Evidence Base for Initial Intervention Strategies for Ending the HIV Epidemic in the U.S., which is sponsored by the U.S. Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services (HHS).
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