What are the results of the Kanawha County HIV outbreak investigation?

West Virginia

CHARLESTON, WV (WOWK) – The Center for Disease Control and Prevention has been in Charleston to conduct an Epi-Aid investigation regarding an HIV outbreak in Kanawha County. Today, the West Virginia Department of Health and Human Resources, Bureau for Public Health met with local and federal partners to share the preliminary findings from that investigation.

The investigation is examining access and barriers to service; assessing behaviors, attitudes and beliefs of people who inject drugs as well as other community stakeholders, and reviewing and analyzing HIV contact tracing procedures as well as additional data that could help identify opportunities for public health intervention.

The Kanawha County Commission reached out to the state’s U.S. Senators in early April seeking help from the CDC to find out where the outbreak is coming from.

“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.”

To get the preliminary findings, the CDC conducted more than 60 in-depth interviews as well as numerous field visits and observations, according to the WV DHHR. The investigation also included data abstraction and analysis.

The WV DHHR says the CDC identified gaps and barriers regarding services in the community as well as gaps in medical services. They say they also identified challenges in accessing those services for people who inject drugs.

According to the preliminary findings, the CDC found:

  • A high use of emergency department and inpatient services among people who inject drugs.
  • And for people who accessed medical services, mostly within emergency departments and inpatient settings:
    • HIV testing was rarely conducted,
    • medication for opioid use disorder was infrequently administered
    • and HIV pre-exposure prophylaxis (PrEP) was not prescribed.

The CDC’s investigation identified the following gaps and barriers associated with services within the community:

  • 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.

According to the WV DHHR, the CDC also found that people who inject drugs commonly reported a “mistrust of the medical system” and said they experienced stigma and discrimination in the systems.

The investigators added, however, multiple local staff and organizations are working to implement “innovative approaches” to prevention and care services for people who inject drugs and developing new partnerships to respond to the HIV outbreak.

“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.”

The response to the HIV outbreak also includes the formation of the Kanawha Valley HIV Testing Outreach Group. The DHHR’s Bureau for Public Health and its partners say they have already tested more than 400 individuals who are at risk for HIV. Health officials say because of the increased access to testing, “nearly a quarter of the positive cases associated with the outbreak were found and linked to care.”

“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.”

The BPH says they have also provided virtual HIV counseling as well as providing testing training to partners such as Quick Response Team members and social service providers. The organization says they are also working with behavioral health providers and state opioid response grantees to integrate HIV prevention and testing into services they provide.

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