Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
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Response to a Large HIV Outbreak, Cabell County, West Virginia, 2018-2019.
McClung RP , Atkins AD , Kilkenny M , Bernstein KT , Willenburg KS , Weimer M , Robilotto S , Panneer N , Thomasson E , Adkins E , Lyss SB , Balleydier S , Edwards A , Chen M , Wilson S , Handanagic S , Hogan V , Watson M , Eubank S , Wright C , Thompson A , DiNenno E , Fanfair RN , Ridpath A , Oster AM . Am J Prev Med 2021 61 S143-s150 INTRODUCTION: In January 2019, the West Virginia Bureau for Public Health detected increased HIV diagnoses among people who inject drugs in Cabell County. Responding to HIV clusters and outbreaks is 1 of the 4 pillars of the Ending the HIV Epidemic in the U.S. initiative and requires activities from the Diagnose, Treat, and Prevent pillars. This article describes the design and implementation of a comprehensive response, featuring interventions from all pillars. METHODS: This study used West Virginia Bureau for Public Health data to identify HIV diagnoses during January 1, 2018-October 9, 2019 among (1) people who inject drugs linked to Cabell County, (2) their sex or injecting partners, or (3) others with an HIV sequence linked to Cabell County people who inject drugs. Surveillance data, including HIV-1 polymerase sequences, were analyzed to estimate the transmission rate and timing of infections using molecular clock phylogenetic analysis. Federal, state, and local partners designed and implemented a comprehensive response during January 2019-October 2019. RESULTS: Of 82 people identified in the outbreak, most were male (60%), were White (91%), and reported unstable housing (80%). In a large molecular cluster containing 56 of 60 (93%) available sequences, 93% of inferred transmissions occurred after January 1, 2018. HIV testing, HIV pre-exposure prophylaxis, and syringe services were rapidly expanded, leading to improved linkage to HIV care and viral suppression. CONCLUSIONS: Evidence of rapid transmission in this outbreak galvanized robust collaboration among federal, state, and local partners, leading to critical improvements in HIV prevention and care services. HIV outbreak response requires increased coordination and creativity to improve service delivery to people affected by rapid HIV transmission. |
HIV Cluster and Outbreak Detection and Response: The Science and Experience.
Oster AM , Lyss SB , McClung RP , Watson M , Panneer N , Hernandez AL , Buchacz K , Robilotto SE , Curran KG , Hassan R , Ocfemia MCB , Linley L , Perez SM , Phillip SAJr , France AM . Am J Prev Med 2021 61 S130-s142 The Respond pillar of the Ending the HIV Epidemic in the U.S. initiative, which consists of activities also known as cluster and outbreak detection and response, offers a framework to guide tailored implementation of proven HIV prevention strategies where transmission is occurring most rapidly. Cluster and outbreak response involves understanding the networks in which rapid transmission is occurring; linking people in the network to essential services; and identifying and addressing gaps in programs and services such as testing, HIV and other medical care, pre-exposure prophylaxis, and syringe services programs. This article reviews the experience gained through 30 HIV cluster and outbreak responses in North America during 2000-2020 to describe approaches for implementing these core response strategies. Numerous jurisdictions that have implemented these response strategies have demonstrated success in improving outcomes related to HIV care and viral suppression, testing, use of prevention services, and reductions in transmission or new diagnoses. Efforts to address important gaps in service delivery revealed by cluster and outbreak detection and response can strengthen prevention efforts broadly through multidisciplinary, multisector collaboration. In this way, the Respond pillar embodies the collaborative, data-guided approach that is critical to the overall success of the Ending the HIV Epidemic in the U.S. initiative. |
HIV diagnoses among persons who inject drugs, by urban-rural classification - United States, 2010-2018
Lyss SB , Zhang T , Oster AM . J Acquir Immune Defic Syndr 2021 88 (3) 238-242 BACKGROUND: Following many years of decline, HIV diagnoses attributed to injection drug use (IDU) in the United States increased in 2015, the year of a large outbreak among persons who inject drugs (PWID) in Indiana. We assessed trends in HIV diagnoses among PWID across the urban-rural continuum. METHODS: We conducted national and county-level analyses of diagnoses among persons aged ≥13 years with HIV attributed to IDU only and reported to the National HIV Surveillance System through December 2019; county of residence at diagnosis was classified according to CDC's National Center for Health Statistics Urban-Rural Classification Scheme. National trends for diagnoses occurring during 2010-2014 and 2014-2018 were assessed by estimated annual percentage change (EAPC). Counties were considered to have an "alert," (i.e., an increase above baseline) if the number of 2019 diagnoses among PWID was >2 standard deviations and >2 diagnoses greater than the mean of annual diagnoses during 2016-2018. RESULTS: Nationally, HIV diagnoses among PWID declined 33% during 2010-2014 from 3314 to 2220 (EAPC: -9.7%; 95% confidence interval [CI]: -10.8 to -8.6); EAPCs declined significantly in five of six urban-rural strata. During 2014-2018, diagnoses increased 11% to 2465 (EAPC: 2.4%; 95%CI: 1.1 to 3.8); EAPCs were >0 for all urban-rural strata, though most were nonsignificant. Alerts were detected in 23 counties, representing five urban-rural strata. CONCLUSIONS: Vigilance is needed for increases in HIV among PWID in counties across the urban-rural continuum, particularly those with indicators of increased drug use. Prompt detection, investigation, and response are critical for stemming transmission. |
The CDC HIV Outbreak Coordination Unit: Developing a Standardized, Collaborative Approach to HIV Outbreak Assessment and Response.
Oster AM , France AM , McClung RP , Buchacz K , Lyss SB , Peters PJ , Weidle PJ , Switzer WM , Phillip SAJr , Brooks JT , Hernandez AL . Public Health Rep 2021 137 (4) 333549211018678 The Centers for Disease Control and Prevention (CDC) and state, territorial, and local health departments have expanded efforts to detect and respond to HIV clusters and outbreaks in the United States. In July 2017, CDC created the HIV Outbreak Coordination Unit (OCU) to ensure consistent and collaborative assessment of requests from health departments for consultation or support on possible HIV clusters and outbreaks of elevated concern. The HIV OCU is a multidisciplinary, cross-organization functional unit within CDC's Division of HIV/AIDS Prevention. HIV OCU members have expertise in areas such as outbreak detection and investigation, prevention, laboratory services, surveillance and epidemiology, policy, communication, and operations. HIV OCU discussions facilitate problem solving, coordination, and situational awareness. Between HIV OCU meetings, designated CDC staff members communicate regularly with health departments to provide support and assessment. During July 2017-December 2019, the HIV OCU reviewed 31 possible HIV clusters and outbreaks (ie, events) in 22 states that were detected by CDC, health departments, or local partners; 17 events involved HIV transmission associated with injection drug use, and other events typically involved sexual transmission or overall increases in HIV diagnoses. CDC supported health departments remotely or on site with planning and prioritization; data collection, management, and analysis; communications; laboratory support; multistate coordination; and expansion of HIV prevention services. The HIV OCU has augmented CDC's support of HIV cluster and outbreak assessment and response at health departments and had important internal organizational benefits. Health departments may benefit from developing or strengthening similar units to coordinate detection and response efforts within and across public health agencies and advance the national Ending the HIV Epidemic initiative. |
HIV detection by an emergency department HIV screening program during a regional outbreak among people who inject drugs
Faryar KA , Ancona RM , Reau Z , Lyss SB , Braun RS , Rademaker T , Sickles RK , Lyons MS . PLoS One 2021 16 (5) e0251756 OBJECTIVE: Multiple HIV outbreaks among persons who inject drugs (PWID) have occurred in the US since 2015. Emergency departments (EDs), recognized as essential venues for HIV screening, may play a unique role in identifying undiagnosed HIV among PWID, who frequently present for complications of injection drug use (IDU). Our objective was to describe changes in HIV diagnoses among PWID detected by an ED HIV screening program and estimate the program's contribution to HIV diagnoses among PWID county-wide during the emergence of a regional HIV outbreak. METHODS: This was a retrospective study of electronically queried clinical records from an urban, safety-net ED's HIV screening program and publicly available HIV surveillance data for its surrounding county, Hamilton County, Ohio. Outcomes included the change in number of HIV diagnoses and the ED's contribution to case identification county-wide, overall and for PWID during 2014-2018. RESULTS: During 2014-2018, the annual number of HIV diagnoses made by the ED program increased from 20 to 42 overall, and from 1 to 18 for PWID. We estimated that the ED contributed 18% of HIV diagnoses in the county and 22% of diagnoses among PWID. CONCLUSIONS: The ED program contributed 1 in 5 new HIV diagnoses among PWID county-wide, further illustrating the importance of ED HIV screening programs in identifying undiagnosed HIV infections. In areas experiencing increasing IDU, HIV screening in EDs can provide an early indication of increasing HIV diagnoses among PWID and can substantially contribute to case-finding during an HIV outbreak. |
Increasing Capacity to Detect Clusters of Rapid HIV Transmission in Varied Populations-United States.
Oster AM , Panneer N , Lyss SB , McClung RP , Watson M , Saduvala N , Ocfemia MCB , Linley L , Switzer WM , Wertheim JO , Campbell E , Hernandez AL , France AM . Viruses 2021 13 (4) Molecular cluster detection analyzes HIV sequences to identify rapid HIV transmission and inform public health responses. We describe changes in the capability to detect molecular clusters and in geographic variation in transmission dynamics. We examined the reporting completeness of HIV-1 polymerase sequences in quarterly National HIV Surveillance System datasets from December 2015 to December 2019. Priority clusters were identified quarterly. To understand populations recently affected by rapid transmission, we described the transmission risk and race/ethnicity of people in clusters first detected in 2018-2019. During December 2015 to December 2019, national sequence completeness increased from 26% to 45%. Of the 1212 people in the 136 clusters first detected in 2018-2019, 69% were men who have sex with men (MSM) and 11% were people who inject drugs (PWID). State-by-state analysis showed substantial variation in transmission risk and racial/ethnic groups in clusters of rapid transmission. HIV sequence reporting has increased nationwide. Molecular cluster analysis identifies rapid transmission in varied populations and identifies emerging patterns of rapid transmission in specific population groups, such as PWID, who, in 2015-2016, comprised only 1% of people in such molecular clusters. These data can guide efforts to focus, tailor, and scale up prevention and care services for these populations. |
Responding to outbreaks of human immunodeficiency virus among persons who inject drugs-United States, 2016-2019: Perspectives on recent experience and lessons learned
Lyss SB , Buchacz K , McClung RP , Asher A , Oster AM . J Infect Dis 2020 222 S239-s249 In 2015, a large human immunodeficiency virus (HIV) outbreak occurred among persons who inject drugs (PWID) in Indiana. During 2016-2019, additional outbreaks among PWID occurred across the United States. Based on information disseminated by responding health departments and Centers for Disease Control and Prevention (CDC) involvement, we offer perspectives about characteristics of and public health responses to 6 such outbreaks. Across outbreaks, injection of opioids (including fentanyl) or methamphetamine predominated; many PWID concurrently used opioids and methamphetamine or cocaine. Commonalities included homelessness or unstable housing, previous incarceration, and hepatitis C virus exposure. All outbreaks occurred in metropolitan areas, including some with substantial harm reduction and medical programs targeted to PWID. Health departments experienced challenges locating case patients and contacts, linking and retaining persons in care, building support to strengthen harm-reduction programs, and leveraging resources. Expanding the concept of vulnerability to HIV outbreaks and other lessons learned can be considered for preventing, detecting, and responding to future outbreaks among PWID. |
Missed opportunities for human immunodeficiency virus (HIV) testing during injection drug use-related healthcare encounters among a cohort of persons who inject drugs with HIV diagnosed during an outbreak-Cincinnati/Northern Kentucky, 2017-2018
Furukawa NW , Blau EF , Reau Z , Carlson D , Raney ZD , Johnson TK , Deputy NP , Sami S , McClung RP , Neblett-Fanfair R , de Fijter S , Ingram T , Thoroughman D , Vogel S , Lyss SB . Clin Infect Dis 2020 72 (11) 1961-1967 BACKGROUND: Persons who inject drugs (PWID) have frequent healthcare encounters related to their injection drug use (IDU) but are often not tested for human immunodeficiency virus (HIV). We sought to quantify missed opportunities for HIV testing during an HIV outbreak among PWID. METHODS: PWID with HIV diagnosed in 5 Cincinnati/Northern Kentucky counties during January 2017-September 2018 who had ≥1 encounter 12 months prior to HIV diagnosis in 1 of 2 Cincinnati/Northern Kentucky area healthcare systems were included in the analysis. HIV testing and encounter data were abstracted from electronic health records. A missed opportunity for HIV testing was defined as an encounter for an IDU-related condition where an HIV test was not performed and had not been performed in the prior 12 months. RESULTS: Among 109 PWID with HIV diagnosed who had ≥1 healthcare encounter, 75 (68.8%) had ≥1 IDU-related encounters in the 12 months before HIV diagnosis. These 75 PWID had 169 IDU-related encounters of which 86 (50.9%) were missed opportunities for HIV testing and occurred among 46 (42.2%) PWID. Most IDU-related encounters occurred in the emergency department (118/169; 69.8%). Using multivariable generalized estimating equations, HIV testing was more likely in inpatient compared with emergency department encounters (adjusted relative risk [RR], 2.72; 95% confidence interval [CI], 1.70-4.33) and at the healthcare system receiving funding for emergency department HIV testing (adjusted RR, 1.76; 95% CI, 1.10-2.82). CONCLUSIONS: PWID have frequent IDU-related encounters in emergency departments. Enhanced HIV screening of PWID in these settings can facilitate earlier diagnosis and improve outbreak response. |
Opioid Use Fueling HIV Transmission in an Urban Setting: An Outbreak of HIV Infection Among People Who Inject Drugs-Massachusetts, 2015-2018.
Alpren C , Dawson EL , John B , Cranston K , Panneer N , Fukuda HD , Roosevelt K , Klevens RM , Bryant J , Peters PJ , Lyss SB , Switzer W , Burrage A , Murray A , Agnew-Brune C , Stiles T , McClung P , Campbell EM , Breen C , Randall LM , Dasgupta S , Onofrey S , Bixler D , Hampton K , Jaeger JL , Hsu KK , Adih W , Callis B , Goldman LR , Danner SP , Jia H , Tumpney M , Board A , Brown C , DeMaria A Jr , Buchacz K . Am J Public Health 2019 110 (1) e1-e8 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. (Am J Public Health. Published online ahead of print November 14, 2019: e1-e8. doi:10.2105/AJPH.2019.305366). |
Yersinia enterocolitica infections associated with improperly pasteurized milk products: southwest Pennsylvania, March-August, 2011
Longenberger AH , Gronostaj MP , Yee GY , Johnson LM , Lando JF , Voorhees RE , Waller K , Weltman AC , Moll M , Lyss SB , Cadwell BL , Gladney LM , Ostroff SM . Epidemiol Infect 2013 142 (8) 1-11 In July 2011, a cluster of Yersinia enterocolitica infections was detected in southwestern Pennsylvania, USA. We investigated the outbreak's source and scope in order to prevent further transmission. Twenty-two persons were diagnosed with yersiniosis; 16 of whom reported consuming pasteurized dairy products from dairy A. Pasteurized milk and food samples were collected from this dairy. Y. enterocolitica was isolated from two products. Isolates from both food samples and available clinical isolates from nine dairy A consumers were indistinguishable by pulsed-field gel electrophoresis. Environmental and microbiological investigations were performed at dairy A and pasteurization deficiencies were noted. Because consumption of pasteurized milk is common and outbreaks have the potential to become large, public health interventions such as consumer advisories or closure of the dairy must be implemented quickly to prevent additional cases if epidemiological or laboratory evidence implicates pasteurized milk as the outbreak source. |
Emergency department HIV screening with rapid tests: a cost comparison of alternative models
Hutchinson AB , Farnham PG , Lyss SB , White DA , Sansom SL , Branson BM . AIDS Educ Prev 2011 23 58-69 Although previous studies have shown that HIV screening in emergency departments (EDs) is feasible, the costs and outcomes of alternative methods of implementing ED screening have not been examined. We compared the costs and outcomes of a model that used the hospital's ED staff to conduct screening, a supplemental staff model that used non-ED staff hired to conduct screening and a hypothetical hybrid model that combined aspects of both approaches. We developed a decision analytic model to estimate the cost per HIV-infected patient identified using alternative ED testing models. The cost per new HIV infection identified was $3,319, $2,084 and $1,850 under the supplemental, existing staff and hybrid models, respectively. Assuming an annual ED census of 50,000 patients, the existing staff model identified 29 more HIV infections than the supplemental model and the hybrid model identified 76 more infections than the existing staff model. Our findings suggest that a hybrid model should be favored over either a supplemental staff or existing staff model in terms of cost per outcome achieved. |
Comparison of survey methods in norovirus outbreak investigation, Oregon, USA, 2009
Oh JY , Bancroft JE , Cunningham MC , Keene WE , Lyss SB , Cieslak PR , Hedberg K . Emerg Infect Dis 2010 16 (11) 1773-6 We compared data from an Internet-based survey and a telephone-based survey during a 2009 norovirus outbreak in Oregon. Survey initiation, timeliness of response, and attack rates were comparable, but participants were less likely to complete Internet questions. Internet-based surveys permit efficient data collection but should be designed to maximize complete responses. |
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