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AIDS and Behavior

, Volume 23, Issue 12, pp 3257–3266 | Cite as

Changes in Reported Injection Behaviors Following the Public Health Response to an HIV Outbreak Among People Who Inject Drugs: Indiana, 2016

  • Sharoda DasguptaEmail author
  • Dita Broz
  • Mary Tanner
  • Monita Patel
  • Brandon Halleck
  • Philip J. Peters
  • Paul J. Weidle
  • Julie O’Donnell
  • Joseph Amlung
  • Cameron McAlister
  • Erika Chapman
  • Ayriane Bailey
  • Janet Burnett
  • Joan Duwve
Original Paper

Abstract

A syringe services program (SSP) was established following the Indiana HIV outbreak among persons who inject drugs (PWID) in Scott County. Among Indiana-based PWID, we examined injection behaviors associated with HIV status, SSP use after its establishment, and changes in injection behaviors after the outbreak response. During 2016, we interviewed 200 PWID and assessed injection behaviors before the response by HIV status. We reported injection behaviors prior to the response and used Fisher’s exact Chi square tests (P < 0.05) to assess differences by HIV status. Next, among persons who injected both before (July–December 2014) and after (past 30 days) the response, we (1) reported the proportion of persons who used the SSP to obtain sterile syringes, and assessed differences in SSP use by HIV status using Fisher’s exact Chi square tests; and (2) compared distributive and receptive sharing of injection equipment and disposal of syringes before and after the outbreak response, and assessed statistical differences using McNemar’s test. We also compared injection behaviors before and after the response by HIV status. Injecting extended release oxymorphone (Opana® ER); receptive sharing of syringes and cookers; and distributive sharing of cookers, filters, or water before the response were associated with HIV infection. SSP use was high (86%), particularly among HIV-positive compared with HIV-negative persons (98% vs. 84%). Injection equipment sharing decreased and safe disposal of used syringes increased after the response, especially among HIV-positive persons. Injection equipment sharing contributed to the outbreak. High SSP use following the response, particularly among HIV-positive persons, contributed to decreased high-risk injection practices.

Keywords

HIV Persons who inject drugs Outbreak Syringe services program 

Notes

Acknowledgements

We acknowledge the dedicated staff of the Indiana State Department of Health and Indiana University, the Scott County Health Department, the Backlot of HOPE Church, and Foundations Family Medicine, without whom this work would not be possible.

References

  1. 1.
    Conrad C, Bradley HM, Broz D, et al. Community outbreak of HIV infection linked to injection drug use of oxymorphone-Indiana, 2015. MMWR Morb Mortal Wkly Rep. 2015;64(16):443–4.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Peters PJ, Pontones P, Hoover KW, et al. HIV infection linked to injection use of oxymorphone in Indiana, 2014-2015. N Engl J Med. 2016;375(3):229–39.CrossRefGoogle Scholar
  3. 3.
    US Census Bureau. QuickFacts: Scott County, Indiana.Google Scholar
  4. 4.
    Vivolo-Kantor AM, Seth P, Gladden RM, et al. Vital signs: trends in emergency department visits for suspected opioid overdoses—United States, July 2016-September 2017. MMWR Morb Mortal Wkly Rep. 2018;67(9):279–85.CrossRefGoogle Scholar
  5. 5.
    Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths—United States, 2010-2015. MMWR Morb Mortal Wkly Rep. 2016;65(5051):1445–52.CrossRefGoogle Scholar
  6. 6.
    Seth P, Scholl L, Rudd RA, Bacon S. Overdose deaths involving opioids, cocaine, and psychostimulants—United States, 2015-2016. MMWR Morb Mortal Wkly Rep. 2018;67(12):349–58.CrossRefGoogle Scholar
  7. 7.
    Warner M, Chen LH, Makuc DM, Anderson RN, Minino AM. Drug poisoning deaths in the United States, 1980-2008. NCHS Data Brief. 2011;81:1–8.Google Scholar
  8. 8.
    United Nations International Narcotics Control Board. Report of the International Narcotics Control Board on the availability of internationally controlled drugs: enduring adequate access for medical and scientific purposes. Vienna: International Narcotics Control Board; 2010.Google Scholar
  9. 9.
    Paulozzi LJ, Mack KA, Hockenberry JM. Variation among states in prescribing of opioid pain relievers and benzodiazepines–United States, 2012. J Saf Res. 2014;51:125–9.CrossRefGoogle Scholar
  10. 10.
    Cicero TJ, Surratt H, Inciardi JA, Munoz A. Relationship between therapeutic use and abuse of opioid analgesics in rural, suburban, and urban locations in the United States. Pharmacoepidemiol Drug Saf. 2007;16(8):827–40.CrossRefGoogle Scholar
  11. 11.
    Mars SG, Bourgois P, Karandinos G, Montero F, Ciccarone D. “Every ‘never’ I ever said came true”: transitions from opioid pills to heroin injecting. Int J Drug Policy. 2014;25(2):257–66.CrossRefGoogle Scholar
  12. 12.
    Kirsh K, Peppin J, Coleman J. Characterization of prescription opioid abuse in the United States: focus on route of administration. J Pain Palliat Care Pharmacother. 2012;26(4):348–61.CrossRefGoogle Scholar
  13. 13.
    Centers for Disease Control and Prevention. Diagnoses of HIV infection in the United States and dependent areas, 2016. Atlanta: Centers for Disease Control and Prevention; 2018.Google Scholar
  14. 14.
    Zibbell JE, Asher AK, Patel RC, et al. Increases in acute hepatitis C virus infection related to a growing opioid epidemic and associated injection drug use, United States, 2004 to 2014. Am J Public Health. 2018;108(2):175–81.CrossRefGoogle Scholar
  15. 15.
    Zibbell JE, Iqbal K, Patel RC, et al. Increases in hepatitis C virus infection related to injection drug use among persons aged ≤ 30 years—Kentucky, Tennessee, Virginia, and West Virginia, 2006-2012. MMWR Morb Mortal Wkly Rep. 2015;64(17):453–8.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Needle RH, Coyle S, Cesari H, et al. HIV risk behaviors associated with the injection process: multiperson use of drug injection equipment and paraphernalia in injection drug user networks. Subst Use Misuse. 1998;33(12):2403–23.CrossRefGoogle Scholar
  17. 17.
    Patel P, Borkowf CB, Brooks JT, Lasry A, Lansky A, Mermin J. Estimating per-act HIV transmission risk: a systematic review. AIDS. 2014;28(10):1509–19.CrossRefGoogle Scholar
  18. 18.
    Battegay M, Bucher HC, Vernazza P. Sexual risk behavior in HIV-infected injection drug users. Clin Infect Dis. 2004;38(8):1175–7.CrossRefGoogle Scholar
  19. 19.
    Backmund M, Reimer J, Meyer K, Gerlach JT, Zachoval R. Hepatitis C virus infection and injection drug users: prevention, risk factors, and treatment. Clin Infect Dis. 2005;40(Suppl 5):S330–5.CrossRefGoogle Scholar
  20. 20.
    Levine OS, Vlahov D, Koehler J, Cohn S, Spronk AM, Nelson KE. Seroepidemiology of hepatitis B virus in a population of injecting drug users. Association with drug injection patterns. Am J Epidemiol. 1995;142(3):331–41.CrossRefGoogle Scholar
  21. 21.
    Centers for Disease Control and Prevention. Reducing harms from injection drug use and opioid use disorder with syringe services programs. Atlanta: Centers for Disease Control and Prevention; 2017.Google Scholar
  22. 22.
    Des Jarlais DC, Marmor M, Paone D, et al. HIV incidence among injecting drug users in New York city syringe-exchange programmes. Lancet. 1996;348(9033):987–91.CrossRefGoogle Scholar
  23. 23.
    Aspinall EJ, Nambiar D, Goldberg DJ, et al. Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: a systematic review and meta-analysis. Int J Epidemiol. 2014;43(1):235–48.CrossRefGoogle Scholar
  24. 24.
    Wodak A, Cooney A. Do needle syringe programs reduce HIV infection among injecting drug users: a comprehensive review of the international evidence. Subst Use Misuse. 2006;41(6–7):777–813.CrossRefGoogle Scholar
  25. 25.
    Holtgrave DR, Pinkerton SD, Jones TS, Lurie P, Vlahov D. Cost and cost-effectiveness of increasing access to sterile syringes and needles as an HIV prevention intervention in the United States. J Acquir Immune Defic Syndr Hum Retrovirol. 1998;18(Suppl 1):S133–8.CrossRefGoogle Scholar
  26. 26.
    NASTAD. Syringe Service program policy environments across the United States. https://www.nastad.org/maps/syringe-service-program-policy-environments-across-united-states.
  27. 27.
    Van Handel MM, Rose CE, Hallisey EJ, et al. County-level vulnerability assessment for rapid dissemination of HIV or HCV infections among persons who inject drugs, United States. J Acquir Immune Defic Syndr. 2016;73(3):323–31.CrossRefGoogle Scholar
  28. 28.
    Cohen MS, McCauley M, Gamble TR. HIV treatment as prevention and HPTN 052. Curr Opin HIV AIDS. 2012;7(2):99–105.CrossRefGoogle Scholar
  29. 29.
    Patel MR, Foote C, Duwve J, et al. Reduction of injection-related risk behaviors after emergency implementation of a syringe services program during an HIV outbreak. J Acquir Immune Defic Syndr. 2018;77(4):373–82.CrossRefGoogle Scholar
  30. 30.
    Indiana State Department of Health. Syringe Exchange Program Guidance for Local Health Departments. 2016.Google Scholar
  31. 31.
    Heckathorn D. Respondent-driven sampling: a new approach to the study of hidden populations. Soc Probl. 1997;44(2):174–99.CrossRefGoogle Scholar
  32. 32.
    CDC. HIV infection, risk, prevention, and testing behaviors among persons who inject drugs–national HIV behavioral surveillance: injection drug use, 20 US cities, 2015. HIV Surveillance Special Report 18; 2017.Google Scholar
  33. 33.
    Broz D, Zibbell J, Foote C, et al. Multiple injections per injection episode: high-risk injection practice among people who injected pills during the 2015 HIV outbreak in Indiana. Int J Drug Policy. 2018;52:97–101.CrossRefGoogle Scholar
  34. 34.
    Bruneau J, Roy E, Arruda N, Zang G, Jutras-Aswad D. The rising prevalence of prescription opioid injection and its association with hepatitis C incidence among street-drug users. Addiction. 2012;107(7):1318–27.CrossRefGoogle Scholar
  35. 35.
    Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep. 2016;65(1):1–49.CrossRefGoogle Scholar
  36. 36.
    Indiana State Department of Health. Syringe service program providing counties, updated 6-20-2018-EC. 2018. http://www.state.in.us/isdh/files/SSP%20Map%20-%20June%202018-EC%20(003).pdf.
  37. 37.
    Murphy EL, DeVita D, Liu H, et al. Risk factors for skin and soft-tissue abscesses among injection drug users: a case-control study. Clin Infect Dis. 2001;33(1):35–40.CrossRefGoogle Scholar
  38. 38.
    Koester S. Following the blood: syringe reuse leads to blood-borne virus transmission among injection drug users. J Acquir Immune Defic Syndr Hum Retrovirol. 1998;18(Suppl 1):S139–40.CrossRefGoogle Scholar
  39. 39.
    Food and Drug Administration. FDA requests removal of Opana ER for risks related to abuse. 2017. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm562401.htm.
  40. 40.
    Mittal ML, Beletsky L, Patino E, et al. Prevalence and correlates of needle-stick injuries among active duty police officers in Tijuana, Mexico. J Int AIDS Soc. 2016;19(4 Suppl 3):20874.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Adams M, An Q, Broz D, Burnett J, Wejnert C, Paz-Bailey G. Distributive syringe sharing and use of syringe services programs among persons who inject drugs (PWID). Conference on retroviruses and opportunistic infections. Boston, MA; March 4-7, 2018.Google Scholar
  42. 42.
    Gowing LR, Farrell M, Bornemann R, Sullivan LE, Ali RL. Brief report: methadone treatment of injecting opioid users for prevention of HIV infection. J Gen Intern Med. 2006;21(2):193–5.CrossRefGoogle Scholar
  43. 43.
    Lawrinson P, Ali R, Buavirat A, et al. Key findings from the WHO collaborative study on substitution therapy for opioid dependence and HIV/AIDS. Addiction. 2008;103(9):1484–92.CrossRefGoogle Scholar
  44. 44.
    Metzger DS, Woody GE, O’Brien CP. Drug treatment as HIV prevention: a research update. J Acquir Immune Defic Syndr. 2010;55(Suppl 1):S32–6.CrossRefGoogle Scholar
  45. 45.
    National Alliance of Advocates for Buprenorphine Treatment. DATA-2000. https://www.naabt.org/data2000.cfm.
  46. 46.
    Department of Justice DEA. Implementation of the provision of the comprehensive addiction and recovery act of 2016 relating to the dispensing of narcotic drugs for opioid use disorder. 2018. https://www.deadiversion.usdoj.gov/fed_regs/rules/2018/fr0123_2.htm.
  47. 47.
    Indiana State Department of Health. HIV Outbreak in Southeastern Indiana. https://www.in.gov/isdh/26649.htm.

Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2019

Authors and Affiliations

  • Sharoda Dasgupta
    • 1
    Email author
  • Dita Broz
    • 1
  • Mary Tanner
    • 1
  • Monita Patel
    • 1
  • Brandon Halleck
    • 3
  • Philip J. Peters
    • 1
  • Paul J. Weidle
    • 1
  • Julie O’Donnell
    • 2
  • Joseph Amlung
    • 3
  • Cameron McAlister
    • 4
  • Erika Chapman
    • 3
  • Ayriane Bailey
    • 3
  • Janet Burnett
    • 1
  • Joan Duwve
    • 4
  1. 1.Division of HIV/AIDS PreventionCenters for Disease Control and PreventionAtlantaUSA
  2. 2.Division of Unintentional Injury PreventionCenters for Disease Control and PreventionAtlantaUSA
  3. 3.Indiana State Department of HealthIndianapolisUSA
  4. 4.Indiana University Richard M. Fairbanks School of Public HealthIndianapolisUSA

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