CROI 2018 Select CDC Studies of Interest

Select CDC Studies on the Impact of Syringe Services Programs Following a Rapidly Spreading HIV Outbreak

A deadly consequence of America’s opioid crisis is the dramatic increase in infectious diseases associated with injection drug use. Syringe-service programs (SSPs) are a key element in a comprehensive response strategy. SSPs increase the chances that people who inject drugs (PWID) will be linked to substance use treatment and stop using drugs. Additionally, data show SSPs can dramatically lower a person’s risk for becoming infected with HIV, viral hepatitis, and other infectious diseases.

Findings from two new CDC analyses to be presented at CROI demonstrate the effectiveness of SSPs and HIV testing and treatment in helping to end a large outbreak of HIV among PWID.

In early 2015, health officials in a small county established an SSP as part of a broad effort to help control an outbreak of more than 200 diagnosed HIV cases in the community. A year later, in January 2016, researchers from CDC, the Indiana State Department of Health, and Indiana University interviewed 200 people (a proportion of whom were HIV positive) in Scott County to learn how their injection behaviors and awareness of HIV prevention tools may have changed after the outbreak.

The findings from the two analyses illustrate that SSPs decreased injection-related risk behaviors, increased uptake of other key testing and prevention services, and increased disposal of syringes safely in the community.

Reported Drug Injection Behaviors Before and After an HIV Outbreak – Indiana, 2016

Poster Presentation, HIV and Drug Use Session, March 7, 2018, 2:30-3:30 p.m.
Overview: Among 124 survey respondents who reported they injected drugs both before and after the SSP was established, researchers found that after the SSP was established:

• The proportion of respondents who shared syringes fell from 74 percent to 22 percent.
• The proportion of respondents using medical waste sharps containers for used syringes increased from 18 percent to 82 percent after the SSP was established.
• A majority of respondents (86 percent) reported using the SSP to obtain sterile syringes and nearly all HIV-positive persons (98 percent) reported using the SSP.

Conclusions: The response to this outbreak, including the establishing of the SSP, decreased injection behaviors associated with the transmission of HIV among people who inject drugs.

CDC Author: Sharoda Dasgupta

Utilization of HIV Testing and Prevention Services Among Persons Who Inject Drugs – Indiana, 2016

Poster Presentation, HIV and Drug Use, March 7, 2018, 2:30-3:30 p.m.
Overview: Interviews with 200 people who inject drugs also showed that HIV testing increased substantially as a result of the outbreak response. Additionally, knowledge of pre-exposure prophylaxis (PrEP), a daily oral medication to help reduce the risk of HIV transmission, was found to be higher for people using the SSP. Key findings include:

• Overall, 185 of the 200 people had been tested for HIV by the time of the study. 39 percent of interviewees were HIV positive. 52 percent of those tested had not been tested before the outbreak was identified, but were tested during or after the outbreak response.
• The SSP was the most commonly used testing site: 21 percent of those reporting the location of their last HIV test were tested at the community outreach center/SSP; 15 percent at jail/prison; 15 percent at home, and the rest used one of several other testing options.
• SSP use was also associated with greater knowledge of PrEP. Interviewees who received an HIV test at the SSP were far more likely to be aware of PrEP compared to interviewees who were not tested at the SSP (53 percent and 32 percent respectively).

Conclusions: SSPs served as an effective forum for delivering HIV testing services and information on PrEP during this outbreak. HIV testing is critical for diagnosing HIV and linking people to care and treatment.
CDC Author: Mary Tanner

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