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. 2025 Feb;29(2):562-583.
doi: 10.1007/s10461-024-04540-7. Epub 2024 Nov 8.

Rapid Assessment Amid an Injection Drug Use-Driven HIV Outbreak in Massachusetts' Merrimack Valley: Highlights from a Case Study

Sabrina S Rapisarda  1   2 , Joseph Silcox  3 , Patricia Case  4 , Wilson R Palacios  5 , Thomas J Stopka  6 , Sofia Zaragoza  3 , Jaclyn M W Hughto  7   8   9   10 , Shikhar Shrestha  6 , Traci C Green  11   12
Affiliations

Rapid Assessment Amid an Injection Drug Use-Driven HIV Outbreak in Massachusetts' Merrimack Valley: Highlights from a Case Study

Sabrina S Rapisarda et al. AIDS Behav. 2025 Feb.

Erratum in

Abstract

Illicitly manufactured fentanyl within the drug supply has substantially increased opioid-related overdose deaths and driven infectious disease outbreaks among people who use drugs (PWUD). Local jurisdictions often lack the data and tools necessary to detect and translate such moments into actionable and effective responses. Informed by a risk environment framework, this case study adopted a mixed-methods design spanning two rapid assessment studies with PWUD in Lowell (n = 90) and Lawrence (n = 40), Massachusetts, during an HIV outbreak (2017, Study 1) and following the outbreak (2019, Study 2). Survey responses (n = 130) were summarized by computing descriptive statistics, ethnographic field notes were reviewed, and qualitative interviews (n = 34) were thematically analyzed to contextualize quantitative findings. Study 1 participants reported constrained syringe access, high injecting frequency, syringe reuse, and unsafe syringe disposal practices, and uncovered entrenched social and structural factors exacerbating existing substance use and HIV risks: housing instability, limited harm reduction supplies and services (e.g., MOUD access), and tensions between law enforcement and PWUD. Following the outbreak and substantial local investments in harm reduction and treatment infrastructures, Study 2 participants indicated lower injection risk reporting fewer syringe reuse episodes, improved syringe disposal practices, high frequency of naloxone administration at recent overdoses, frequent testing for HIV and HCV, and greater engagement with syringe services programs. A rapid assessment approach to fentanyl's emergence and a concomitant HIV outbreak provided time-sensitive, critical insights and identified needed and local response strategies. However, unless social and structural risk factors are also addressed, community vulnerability to future HIV outbreaks remains.

Keywords: Fentanyl; HIV outbreak; PWUD; Rapid assessments; Substance use; Syringe service programs.

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Conflict of interest statement

Declarations. Ethical Approval: Approval was granted by the Institutional Review Boards of Boston University Medical Center and the Massachusetts Department of Public Health. Informed Consent: Informed consent was obtained from all study participants. Conflict of Interest: All authors of this manuscript have no conflict of interest to declare pertaining to the content of this article.

Figures

Fig. 1
Fig. 1
Timeline of events surrounding HIV outbreak in Lawrence and Lowell, Massachusetts, 2013–2020
See this image and copyright information in PMC

References

    1. O’Donnell J, Gladden RM, Goldberger BA, Mattson CL, Kariisa M. Notes from the field: opioid-involved overdose deaths with fentanyl or fentanyl analogs detected—28 states and the District of Columbia, July 2016–December 2018. MMWR Morb Mortal Wkly Rep. 2020;69(10):271–3. 10.15585/mmwr.mm6910a4. - PMC - PubMed
    1. Gladden RM, Martinez P, Seth P. Fentanyl law enforcement submissions and increases in synthetic opioid-involved overdose deaths – 27 states, 2013–2014. MMWR Morb Mortal Wkly Rep. 2016;65(33):837–43. 10.15585/mmwr.mm6533a2. - PubMed
    1. Centers for Disease Control and Prevention. Provisional drug overdose death counts. Accessed January 10. 2024. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm#COD_classifica...
    1. Schoenberg S. Massachusetts Gov. Charlie Baker signs law making fentanyl trafficking a crime. MassLive. November 24, 2015. Accessed January 10, 2024. https://www.masslive.com/politics/2015/11/gov_charlie_baker_signs_law_ma...
    1. Mass.gov. Current overdose data. Updated data – As of December 2023. Accessed January 10. 2024. https://www.mass.gov/lists/current-overdose-data

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