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. 2016 Nov 1;73(3):323-331.
doi: 10.1097/QAI.0000000000001098.

County-Level Vulnerability Assessment for Rapid Dissemination of HIV or HCV Infections Among Persons Who Inject Drugs, United States

Michelle M Van Handel  1 , Charles E Rose, Elaine J Hallisey, Jessica L Kolling, Jon E Zibbell, Brian Lewis, Michele K Bohm, Christopher M Jones, Barry E Flanagan, Azfar-E-Alam Siddiqi, Kashif Iqbal, Andrew L Dent, Jonathan H Mermin, Eugene McCray, John W Ward, John T Brooks
Affiliations

County-Level Vulnerability Assessment for Rapid Dissemination of HIV or HCV Infections Among Persons Who Inject Drugs, United States

Michelle M Van Handel et al. J Acquir Immune Defic Syndr. .

Abstract

Objective: A recent HIV outbreak in a rural network of persons who inject drugs (PWID) underscored the intersection of the expanding epidemics of opioid abuse, unsterile injection drug use (IDU), and associated increases in hepatitis C virus (HCV) infections. We sought to identify US communities potentially vulnerable to rapid spread of HIV, if introduced, and new or continuing high rates of HCV infections among PWID.

Design: We conducted a multistep analysis to identify indicator variables highly associated with IDU. We then used these indicator values to calculate vulnerability scores for each county to identify which were most vulnerable.

Methods: We used confirmed cases of acute HCV infection reported to the National Notifiable Disease Surveillance System, 2012-2013, as a proxy outcome for IDU, and 15 county-level indicators available nationally in Poisson regression models to identify indicators associated with higher county acute HCV infection rates. Using these indicators, we calculated composite index scores to rank each county's vulnerability.

Results: A parsimonious set of 6 indicators were associated with acute HCV infection rates (proxy for IDU): drug-overdose deaths, prescription opioid sales, per capita income, white, non-Hispanic race/ethnicity, unemployment, and buprenorphine prescribing potential by waiver. Based on these indicators, we identified 220 counties in 26 states within the 95th percentile of most vulnerable.

Conclusions: Our analysis highlights US counties potentially vulnerable to HIV and HCV infections among PWID in the context of the national opioid epidemic. State and local health departments will need to further explore vulnerability and target interventions to prevent transmission.

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Figures

Figure 1
Figure 1
Multi-step approach to identify counties with greatest vulnerability to rapid dissemination of injection drug use-associated HIV infection, if introduced, and new or continued Hepatitis C virus infections.
Figure 2
Figure 2
Counties for which estimated vulnerability scores or their upper 90% confidence interval exceeded the 95th percentile. Map produced by the Geospatial Research, Analysis, and Services Program (GRASP).
Figure 3
Figure 3
Estimated rate of people living with diagnosed HIV infection (PLWH) per 10,000 population in and around each vulnerable county at year-end 2012. The weighted average rate of people living with diagnosed HIV infection in the vulnerable county (inset A) and 20 miles beyond the vulnerable county border (inset B) was calculated using the area proportion of each adjacent county within the 20 mile buffer zone and the number of PLWH and county population estimates at year-end 2012. Map produced by the Geospatial Research, Analysis, and Services Program (GRASP).
See this image and copyright information in PMC

Comment in

  • Rural Health More Than Just "Big Data".
    Westfall JM. Westfall JM. J Acquir Immune Defic Syndr. 2017 Mar 1;74(3):e84. doi: 10.1097/QAI.0000000000001195. J Acquir Immune Defic Syndr. 2017. PMID: 27787341 No abstract available.
  • Reply.
    Van Handel MM, Brooks JT. Van Handel MM, et al. J Acquir Immune Defic Syndr. 2017 Mar 1;74(3):e84-e85. doi: 10.1097/QAI.0000000000001262. J Acquir Immune Defic Syndr. 2017. PMID: 28187087 No abstract available.

References

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    1. Zibbell JE, Iqbal K, Patel RC, et al. Increases in hepatitis C virus infection related to injection drug use among persons aged </=30 years - Kentucky, Tennessee, Virginia, and West Virginia, 2006–2012. MMWR Morb Mortal Wkly Rep. 2015;64(17):453–8. - PMC - PubMed
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