January 13, 2016
3 min read

Prevention strategy focuses on HIV epidemic in Indiana

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An HIV prevention initiative will be launched in Scott County, Indiana, in an international effort to help control an outbreak there, according to a press release.

On March 25, Indiana Gov. Mike Pence declared a public health disaster emergency after a substantial number of HIV diagnoses were reported in Scott County. According to the CDC, the majority of cases were linked to syringe-sharing partners. Approximately 10% of the population in Austin, a rural community in Scott County, inject opioids on a daily basis, the release said. Since last year, 184 new HIV infections were diagnosed in the community of 4,200 residents.

Researchers implement HIV ‘Treatment as Prevention’ model

To curb the spread of infection, researchers from the Indiana University (IU) School of Medicine and the BC Centre for Excellence in HIV/AIDS in British Columbia will employ the “Treatment as Prevention” model, which involves strategies and technologies that have previously shown to increase access to early and continuous HIV care and reduce stigma, according to the release.

“Treatment as Prevention has been implemented across diverse international jurisdictions from China to Panama to major cities within the United States,” Julio Montaner, MD, director of the BC Centre for Excellence in HIV/AIDS, said in the release. “The situation in Indiana marks a critical need for implementing best practices in harm reduction and HIV prevention.”

The initiative is supported by a 2-year, $200,000 grant from the National Institute on Drug Abuse and additional funding from the IU School of Medicine. By providing consistent treatment and care, individual viral load will decrease, reducing the likelihood of disease progression and secondary cases, Montaner said.

Jerome M. Adams, MD, MPH

Jerome M. Adams

“Ideally, we would like to stop HIV from entering communities in the first place,” Indiana State Health Commissioner Jerome M. Adams, MD, MPH, told Infectious Disease News. “However, in situations such as Scott County, where we now have more than 180 HIV-positive individuals, the best and most practical way to prevent spread is by ensuring those individuals are virally suppressed via prompt and proper [antiretroviral] treatment. The IU/BC partnership is a huge step in that direction.”

Through the effort, researchers will identify factors that affect an individual’s decision to seek and continue care, apply mapping technology to track risk factors for HIV transmission, and use laboratory-based research to anonymously monitor transmission clusters. They also will expand harm reduction services and other programs at the patient- and system-level to counter the public health harms of injection drug use, the release said.

Needle exchange program reduces syringe-sharing among injection drug users

Prior to the treatment as prevention initiative, a needle exchange program (NEP) was temporarily launched in Scott County in response to the outbreak. Previously, NEPs were illegal in Indiana.

The impact of the NEP was assessed by Monita R. Patel, PhD, MPH, from the CDC, and colleagues, who reported their findings at IDWeek 2015. During their investigation, Patel and colleagues compared injection-related risk behaviors reported over time by 148 (62%) of its clients. Each participant utilized the NEP service at least twice. They received sterile syringes, a wound kit, harm reduction education and referrals to health and substance use treatment services, and completed surveys about current risk behaviors.

Monita R. Patel, PhD, MPH

Monita R. Patel

The proportion of injection drug users (IDUs) who shared syringes decreased from 18% at the first visit to 2% at the last visit (P < .001). The median frequency of IDUs reusing the same syringe also decreased from two times at the first visit to one time at the last visit (P < .001). The median number of syringes returned increased (0 to 57; P < .001), as did the number of new syringes distributed (35 to 63; P < .001). The researchers also saw a decrease in the percentage of IDUs sharing syringes to divide drugs (19% to 4%; P < .001) and the sharing of other injection equipment (24% to 5%; P < .001). However, the frequency of reported injections per day increased over time (5 to 9; P < .001).

In more recent data, Monica S. Ruiz, PhD, MPH, assistant research professor in the department of prevention and community health at George Washington University’s Milken Institute School of Public Health, and colleagues found that a needle exchange program implemented in Washington, D.C., in 2008 prevented 120 new HIV infections in the span of 2 years and saved $44.3 million in health care costs.

In December, an omnibus bill passed by the Senate and the House included increased funding for certain components of syringe services programs.

Jonathan Mermin

“Outbreaks in Indiana and elsewhere have been powerful reminders that people who inject drugs can be at very high risk for HIV and hepatitis C, and studies have shown that syringe services programs are cost-saving, and can reduce the risk of infection,” Jonathan Mermin, MD, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said in a press release. “CDC has historically recommended that states ensure people who inject drugs have access to integrated prevention services from a reliable source, including sterile injection equipment, opioid therapy, and HIV and hepatitis testing. Congress’ decision makes that job easier.”


Patel MR, et al. Abstract 638a. Presented at: IDWeek; Oct. 7-11, 2015; San Diego.

Ruiz MS, et al. AIDS Behav. 2015;doi:10.1007/s10461-015-1143-6.

Disclosure: The researchers report no relevant financial disclosures.