McClung R Paul, Atkins Amy D, Kilkenny Michael, Bernstein Kyle T, Willenburg Kara S, Weimer Matthew, Robilotto Susan, Panneer Nivedha, Thomasson Erica, Adkins Elizabeth, Lyss Sheryl B, Balleydier Shawn, Edwards Anita, Chen Mi, Wilson Suzanne, Handanagic Senad, Hogan Vicki, Watson Meg, Eubank Scott, Wright Carolyn, Thompson Antoine, DiNenno Elizabeth, Fanfair Robyn Neblett, Ridpath Alison, Oster Alexandra M
Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia; U.S. Public Health Service Commissioned Corps, Atlanta, Georgia.
West Virginia Department of Health & Human Resources, West Virginia Bureau for Public Health, Charleston, West Virginia.
Am J Prev Med. 2021 Nov;61(5 Suppl 1):S143-S150. doi: 10.1016/j.amepre.2021.05.039.
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.
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.
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.
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.
2019年1月，西弗吉尼亚州公共卫生局发现卡贝尔县注射毒品者中的艾滋病毒诊断病例有所增加。应对艾滋病毒聚集性感染和疫情爆发是美国“终结艾滋病毒流行”倡议的四大支柱之一，需要诊断、治疗和预防这三大支柱开展相关活动。本文描述了一项综合应对措施的设计与实施情况，该措施包含了来自所有支柱的干预措施。
本研究利用西弗吉尼亚州公共卫生局的数据，确定了2018年1月1日至2019年10月9日期间的艾滋病毒诊断情况，涉及以下三类人群：（1）与卡贝尔县有关联的注射毒品者；（2）他们的性伴侣或注射伙伴；（3）其他艾滋病毒序列与卡贝尔县注射毒品者有关联的人。利用分子钟系统发育分析对监测数据（包括HIV-1聚合酶序列）进行分析，以估计感染的传播率和时间。联邦、州和地方合作伙伴在2019年1月至2019年10月期间设计并实施了一项综合应对措施。
在此次疫情中确定的82人中，大多数为男性（60%），白人（91%），且报告住房不稳定（80%）。在一个包含60个可用序列中的56个（93%）的大分子簇中，93%的推断传播发生在2018年1月1日之后。艾滋病毒检测、艾滋病毒暴露前预防和注射器服务迅速扩大，从而改善了与艾滋病毒治疗的联系并实现了病毒抑制。
此次疫情中快速传播的证据促使联邦、州和地方合作伙伴展开了强有力的合作，从而在艾滋病毒预防和护理服务方面取得了关键进展。应对艾滋病毒疫情需要加强协调并发挥创造力，以改善向受艾滋病毒快速传播影响人群提供的服务。
