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. 2018 Mar 29;13(3):e0194799.
doi: 10.1371/journal.pone.0194799. eCollection 2018.

Potential geographic "hotspots" for drug-injection related transmission of HIV and HCV and for initiation into injecting drug use in New York City, 2011-2015, with implications for the current opioid epidemic in the US

D C Des Jarlais  1 , H L F Cooper  2 , K Arasteh  1 , J Feelemyer  1 , C McKnight  1 , Z Ross  3
Affiliations

Potential geographic "hotspots" for drug-injection related transmission of HIV and HCV and for initiation into injecting drug use in New York City, 2011-2015, with implications for the current opioid epidemic in the US

D C Des Jarlais et al. PLoS One. .

Abstract

Objective: We identified potential geographic "hotspots" for drug-injecting transmission of HIV and hepatitis C virus (HCV) among persons who inject drugs (PWID) in New York City. The HIV epidemic among PWID is currently in an "end of the epidemic" stage, while HCV is in a continuing, high prevalence (> 50%) stage.

Methods: We recruited 910 PWID entering Mount Sinai Beth Israel substance use treatment programs from 2011-2015. Structured interviews and HIV/ HCV testing were conducted. Residential ZIP codes were used as geographic units of analysis. Potential "hotspots" for HIV and HCV transmission were defined as 1) having relatively large numbers of PWID 2) having 2 or more HIV (or HCV) seropositive PWID reporting transmission risk-passing on used syringes to others, and 3) having 2 or more HIV (or HCV) seronegative PWID reporting acquisition risk-injecting with previously used needles/syringes. Hotspots for injecting drug use initiation were defined as ZIP codes with 5 or more persons who began injecting within the previous 6 years.

Results: Among PWID, 96% injected heroin, 81% male, 34% White, 15% African-American, 47% Latinx, mean age 40 (SD = 10), 7% HIV seropositive, 62% HCV seropositive. Participants resided in 234 ZIP codes. No ZIP codes were identified as potential hotspots due to small numbers of HIV seropositive PWID reporting transmission risk. Four ZIP codes were identified as potential hotspots for HCV transmission. 12 ZIP codes identified as hotspots for injecting drug use initiation.

Discussion: For HIV, the lack of potential hotspots is further validation of widespread effectiveness of efforts to reduce injecting-related HIV transmission. Injecting-related HIV transmission is likely to be a rare, random event. HCV prevention efforts should include focus on potential hotspots for transmission and on hotspots for initiation into injecting drug use. We consider application of methods for the current opioid epidemic in the US.

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Conflict of interest statement

Competing Interests: We have the following interests. ZevRoss Spatial Analysis was founded by co-author Z. Ross. There are no patents, products in development or marketed products to declare. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

Figures

Fig 1
Fig 1. Number of participants by ZIP code in the 5 boroughs of New York City.
Fig 2
Fig 2. ZIP codes and distribution of HIV Positive PWID with distributive sharing; ZIP codes and distribution of HIV Negative PWID with receptive sharing; ZIP codes and distribution of HCV Positive PWID with distributive sharing; ZIP codes and distribution of HCV Negative PWID with receptive sharing.
Fig 3
Fig 3. Potential hotspots for HCV transmission among PWID in the 5 boroughs of New York City.
Fig 4
Fig 4. Potential initiation hotspots among PWID in the 5 boroughs of New York City.
See this image and copyright information in PMC

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