Tennessee Department of Health, Nashville, TN, United States of America.
Vanderbilt University School of Medicine, Departments of Medicine and Biostatistics, Nashville, TN, United States of America.
PLoS One. 2022 Aug 4;17(8):e0270891. doi: 10.1371/journal.pone.0270891. eCollection 2022.
Human immunodeficiency virus (HIV), hepatitis C virus (HCV), and injection drug use are syndemic in the central Appalachian states. In Tennessee (TN), declines in HIV among persons who inject drugs (PWID) stalled, and HCV infection rates increased significantly from 2013-2017. To better target strategies to address the syndemic, county-level socioeconomic, opioid use, access to healthcare, and health factors were modeled to identify indicators predictive of vulnerability to an HIV/HCV outbreak among PWID in TN.
Newly reported chronic HCV cases among persons aged 13-39 years in 2016-2017 were used as a proxy for county-level HIV/HCV vulnerability among TN's 95 counties. Seventy-five publicly available county-level measures from 2016-2017 were collected and reduced through multiple dimension reduction techniques. Negative binomial regression identified indicators associated with HCV which were used to calculate county-level vulnerability to a local HIV/HCV outbreak.
Thirteen county-level indicators were identified as strongly predictive of HIV/HCV vulnerability with the statistically significant indicators being percentage of the population aged 20-44 years, per capita income, teen birth rate, percentage of clients in TDMHSAS-funded opioid treatment and recovery, syphilis case rate, and percentage of homes with at least one vehicle. Based on the 13 indicators, we identified the distribution of vulnerability to an HIV/HCV outbreak among TN's counties. Eleven high vulnerability counties were identified, with the preponderance located in east and middle TN.
This analysis identified the county-level factors most associated with vulnerability to an HIV/HCV outbreak among PWID in TN. These results, alongside routine surveillance, will guide targeted prevention and linkage to care efforts for the most vulnerable communities.
人类免疫缺陷病毒（HIV）、丙型肝炎病毒（HCV）和注射吸毒在中阿巴拉契亚各州呈综合征流行。在田纳西州（TN），注射吸毒者（PWID）中的 HIV 下降趋势停滞，HCV 感染率在 2013-2017 年间显著上升。为了更好地确定针对该综合征的策略，对县一级的社会经济、阿片类药物使用、获得医疗保健的机会以及健康因素进行建模，以确定田纳西州 PWID 中 HIV/HCV 爆发的易感性指标。
以 2016-2017 年年龄在 13-39 岁的新报告慢性 HCV 病例作为田纳西州 95 个县 HIV/HCV 脆弱性的代表。收集了 2016-2017 年 75 个公开的县级指标，并通过多种维度减少技术进行了简化。负二项回归确定了与 HCV 相关的指标，用于计算县级 HIV/HCV 局部爆发的易感性。
确定了 13 个县级指标作为 HIV/HCV 脆弱性的强预测指标，具有统计学意义的指标为 20-44 岁人口比例、人均收入、青少年出生率、接受 TDMHSAS 资助的阿片类药物治疗和康复的客户比例、梅毒病例率和至少有一辆车的家庭比例。基于这 13 个指标，我们确定了田纳西州各县 HIV/HCV 爆发的脆弱性分布。确定了 11 个高脆弱性县，其中绝大多数位于田纳西州东部和中部。
本分析确定了与田纳西州 PWID 中 HIV/HCV 爆发易感性最相关的县级因素。这些结果，以及常规监测，将指导针对最脆弱社区的有针对性的预防和获得护理工作。
