CHARLESTON — The West Virginia Department of Health and Human Resources (DHHR), Bureau for Public Health met with local and federal partners June 24 to share preliminary findings from the U.S. Centers for Disease Control and Prevention (CDC) regarding the HIV outbreak in Kanawha County.
As part of the ongoing response to this outbreak, the CDC has been in Charleston conducting an Epi-Aid investigation to further examine access and barriers to services; assess behaviors, attitudes and beliefs of people who inject drugs and other community stakeholders; and review and analyze HIV contact tracing procedures and other data to help identify potential opportunities for public health intervention. The CDC presented its preliminary findings today.
The preliminary findings were informed by more than 60 in-depth interviews and numerous field visits and observations, in addition to time spent conducting data abstraction and analysis. The investigation identified gaps and barriers associated with services in the community and gaps in medical services and challenges in accessing them for people who inject drugs. Findings include:
• high use of emergency department and inpatient services among people who inject drugs.
• for those who accessed medical services (mostly in emergency departments and inpatient settings):
o HIV testing was rarely conducted,
o medication for opioid use disorder was infrequently administered
o and HIV pre-exposure prophylaxis (PrEP) was not prescribed.
The investigation additionally identified gaps and barriers associated with services in the community, including:
• low access to sterile syringes and injection equipment,
• challenges in accessing and navigating substance use disorder treatment and HIV prevention services and treatment,
• and people at highest risk for HIV not regularly receiving HIV testing.
People who inject drugs also commonly reported mistrust of the medical system along with experiencing stigma and discrimination in these systems.
Investigators noted numerous local staff and organizations working to implement innovative approaches to delivering prevention and care services for people who inject drugs, and new partnerships continuing to develop in response to the HIV outbreak.
“We are thankful for all the hard work the CDC Epi Aid team, the Kanawha-Charleston Health Department, and many others have done, especially through this last month,” said Dr. Ayne Amjad, State Health Officer and Commissioner of DHHR’s Bureau for Public Health. “The Bureau will provide full recommendations when they are available sometime in August and will work as a team to address them.”
DHHR’s Bureau for Public Health and partners have continued to respond to the HIV outbreak through the formation of the Kanawha Valley HIV Testing Outreach Group, which has tested more than 400 individuals at risk for HIV. As a result of increased access to testing and outreach, nearly a quarter of the positive cases associated with the outbreak were found and linked to care.
“Our team on the ground continues to conduct rapid HIV testing, refer patients to care and prevention services (including services that support continuity of care), and address mental health, opioid misuse, and primary care needs,” Amjad said. “We believe that a whole community and whole health care model approach is the best way to address any infectious disease outbreak.”
Additionally, BPH has provided virtual HIV counseling and testing training to non-traditional partners such as community Quick Response Team members and social service providers (shelters, food distribution) and is working with behavioral health providers and state opioid response grantees to integrate HIV testing and prevention into provided services.
“Responding to this increase in HIV cases in our community requires us to adapt the way we deliver services,” said Dr. Sherri Young, Health Officer for the Kanawha-Charleston Health Department. “Our community partners have worked collaboratively to enhance, integrate and position both fixed and mobile services that meet people where they are. Our local, state and federal partners have all been instrumental in helping to guide this important work.”
Final recommendations will be made sometime in August.