Opioid Use Fueling HIV Transmission in an Urban Setting: An Outbreak of HIV Infection Among People Who Inject Drugs-Massachusetts, 2015-2018

Abstract

Objectives. To describe and control an outbreak of HIV infection among people who inject drugs (PWID).Methods. The investigation included people diagnosed with HIV infection during 2015 to 2018 linked to 2 cities in northeastern Massachusetts epidemiologically or through molecular analysis. Field activities included qualitative interviews regarding service availability and HIV risk behaviors.Results. We identified 129 people meeting the case definition; 116 (90%) reported injection drug use. Molecular surveillance added 36 cases to the outbreak not otherwise linked. The 2 largest molecular groups contained 56 and 23 cases. Most interviewed PWID were homeless. Control measures, including enhanced field epidemiology, syringe services programming, and community outreach, resulted in a significant decline in new HIV diagnoses.Conclusions. We illustrate difficulties with identification and characterization of an outbreak of HIV infection among a population of PWID and the value of an intensive response.Public Health Implications. Responding to and preventing outbreaks requires ongoing surveillance, with timely detection of increases in HIV diagnoses, community partnerships, and coordinated services, all critical to achieving the goal of the national Ending the HIV Epidemic initiative.

FIGURE 1—

Cumulative HIV Diagnoses and Timeline of Investigation and Response to Outbreak of HIV: Massachusetts, 2015–2018 Note. CDC = Centers for Disease Control and Prevention; IDU = injection drug use; MDPH = Massachusetts Department of Public Health; PWID = people who inject drugs; SSP = syringe services program.

FIGURE 2—

Network Diagram of Needle Sharing or Sex Partner Interactions, as of September 30, 2018, Stratified by HIV Status and Molecular Cluster: Massachusetts, January 2015–June 2018

FIGURE 3—

Diagnoses of HIV Among People Who Inject Drugs Statewide Showing Cases Linked to Lawrence and Lowell, Massachusetts: 2006–2018 ^a2018 data are preliminary.