Philadelphia Department of Public Health, Philadelphia, Pennsylvania.
J Infect Dis. 2020 Sep 2;222(Suppl 5):S250-S258. doi: 10.1093/infdis/jiaa128.
In 2018, Philadelphia identified an outbreak of new human immunodeficiency virus (HIV) infections among persons who inject drugs (PWID). Although conventional HIV surveillance systems capture individual-level behavioral risk, they are not able to capture the social and environmental factors contributing to rapid transmission.
HIV surveillance data were used to assess demographic, clinical, and behavioral factors for PWID with HIV diagnosed during 2017 and 2018. Social factors such as homelessness, disruption of encampments, and trends in sexual behaviors, drug use and syringe availability among PWID were captured through National HIV Behavioral Surveillance, routine hepatitis and sexually transmitted infection surveillance, and shelter and homeless outreach data.
In 2018, there were 71 new infections among PWID, an increase of 115% since 2016. During this time, opioid overdose deaths peaked at 59 deaths per 100 000 persons, 85% of which involved the use of fentanyl. While overall reported homelessness increased, rates of those living unsheltered rose by 13%. The Philadelphia Department of Public Health identified increased injection frequency, encampment closures, and lack of syringe access as promoters of continued HIV transmission.
The use of conventional surveillance methods only is inadequate for determining HIV risk during outbreaks. Incorporation of individual and aggregate level data on social and environmental determinants is necessary to develop effective outbreak response interventions.
2018 年，费城发现了一批新的艾滋病毒（HIV）感染病例，这些病例都出现在注射毒品者（PWID）当中。尽管传统的 HIV 监测系统能够捕捉到个体层面的行为风险，但它们无法捕捉到导致快速传播的社会和环境因素。
使用 HIV 监测数据评估 2017 年和 2018 年期间诊断出的 HIV 感染 PWID 的人口统计学、临床和行为因素。通过国家 HIV 行为监测、常规肝炎和性传播感染监测以及庇护所和无家可归者外展数据，捕捉了社会因素，如无家可归、营地被破坏以及 PWID 中的性行为、吸毒和使用注射器的趋势。
2018 年，有 71 例新感染病例，自 2016 年以来增加了 115%。在此期间，阿片类药物过量死亡人数达到每 10 万人中有 59 人死亡，其中 85%涉及芬太尼的使用。尽管总体报告的无家可归人数增加，但无家可归者的比例上升了 13%。费城公共卫生部确定了注射频率增加、营地关闭和缺乏注射器获取途径是继续传播 HIV 的促进因素。
仅使用传统监测方法不足以确定疫情期间的 HIV 风险。必须将社会和环境决定因素的个人和总体水平数据纳入其中，以制定有效的疫情应对干预措施。
