HIV Infections Associated with Injection Drug Use in the Greater Cincinnati Region
CDC Findings & Recommendations
In 2017, the number of HIV infections among PWID increased in Northern Kentucky and Hamilton County, Ohio. This trend continued in 2018, with injection drug use surpassing sexual transmission as the leading risk factor for HIV in Northern Kentucky. Local and state health departments have been investigating and responding to this problem, and in late 2018, a disease investigation team (Epi-Aid) was requested from the CDC.
The CDC team came to the greater Cincinnati region and assessed information systems, reviewed HIV data and medical records, and interviewed health care providers, law enforcement, and people who inject drugs. Based on their observations and the information gathered, the team compiled their findings and recommendations for additional prevention and control measures to effectively reduce the spread of HIV among PWID in our region.
*=provisional data that is subject to change
The CDC Epi-Aid Team spent about a month in Cincinnati and Northern Kentucky and at the end of investigation, presented the following preliminary findings:
- HIV is being transmitted rapidly among PWID between Northern Kentucky and the Cincinnati metro region. Although many cases have been diagnosed early in their infection, some had advanced disease at their time of diagnosis.
- New HIV infections continue to be diagnosed without any evidence of decline. Most infections are among white males, 20-39 years old.
- Sharing and reuse of needles and injection equipment among PWID exists and drives increases in HIV and hepatitis. Therefore, opportunities are needed to increase accessibility of syringe services programs to prevent disease.
- Mental health issues and stigma are barriers to receiving services for HIV, substance use, housing, and other support services. Although PWID with HIV had high rates of enrollment in HIV care, less than half stayed in care for enough time to achieve viral loads low enough to prevent the spread of HIV to others. In addition, PWID only modestly access substance use treatment.
- Missed opportunities for early HIV diagnosis were identified. Earlier HIV diagnosis means linkage to care sooner in the disease. Most PWID with HIV had at least one medical visit where they could have found out their HIV status sooner if they had been tested at that visit. In addition, most PWID did not know that there are medications that can be taken daily to prevent HIV infection.
Based on the findings, the CDC Epi-Aid team recommended the following actions in the greater Cincinnati region to help prevent the spread of HIV among PWID:
- Improve the delivery of comprehensive syringe services programs to expand prevention and treatment services. This includes making a wider range of health and social services more accessible at more locations, providing the amount of new equipment participants need to eliminate sharing and increasing prevention education.
- Expand HIV testing by community partners especially in jails and emergency departments for people with injection drug use related visits.
- Improve coordination of services for PWID including HIV testing and care, mental health services, substance use treatment, housing, and support services.
- Continue efforts to share and integrate data across the Kentucky and Ohio local and state health departments.
Local public health officials also recommend increasing awareness of and access to Pre-Exposure Prophylaxis (PrEP) – medication that when taken daily, can prevent HIV infection in people at risk.
As a result of these recommendations, the local health departments in the greater Cincinnati region and the state health departments in Ohio and Kentucky will work together across jurisdictions to take the next steps:
- Share the findings and recommendations with the public, elected officials, community partners, and stakeholders.
- Incorporate recommendations into regional response plans and efforts. This will include identifying opportunities to collaborate with community partners to carry out the recommendations.
- Identify additional resources needed to implement recommended strategies.
- Partner to educate and advocate for policy changes needed.
- Link data and share information to better coordinate services across jurisdictions.
- Work with CDC to improve HIV case detection and service delivery.