There are lessons to learn from the response to the injection drug use-related outbreak of HIV and hepatitis C virus (HCV) in rural Indiana, aidsmap reports. Researchers presented information about the response to the localized epidemic at the 8th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Vancouver, British Columbia.
At least 175 people in a community of 4,200 were recently diagnosed HIV, with 96 percent of them reporting injection drug use. Ninety-two percent of the group is coinfected with hep C. The epidemic recently plateaued.
Investigators traced the sexual or needle-sharing contacts of those diagnosed with HIV. Almost 500 contacts in all were traced, 83 percent of whom were tested for HIV.
The affected population has a high unemployment rate, and most were uninsured. The county school system teaches abstinence-only sex education, and does not provide comprehensive information on how to prevent HIV. There was also no local medication-assisted or opiate substitution therapy to treat the highly prevalent addiction in the area.
To work with all these challenges, public health officials established an easily accessible single location where people could go to coordinate their medical and addiction care, receive vaccines, obtain crucial documents, undergo job training, and receive assistance getting Medicaid. Indiana recently expanded Medicaid under the Affordable Care Act.
The state gave extra money to expand HIV testing and care, and increase access to Truvada (tenofovir/emtricitabine) as pre-exposure prophylaxis (PrEP). About 70 percent of those newly diagnosed with HIV entered care for the virus, and 40 percent started antiretrovirals. Various barriers, including exorbitant costs, have made securing hep C treatment more challenging.
Public health officials also started an HIV and hep C testing campaign and also sent a flyer about testing to local residents. There were also billboards and bus shelter ads that discouraged needle sharing.
The governor of Indiana, Mike Pence, shifted policy to permit needle exchange programs in March.
To read the aidsmap article, click here.
To read a POZ exclusive on the HIV and hep C outbreaks, click here.