Top 5 Takeaways

1. Increasing HIV Diagnoses: The number of HIV diagnoses among persons who inject drugs (PWID) in Kanawha County rose significantly from less than five annually during 2016–2018 to 11 in the first ten months of 2019.
2. Impact of COVID-19: The COVID-19 pandemic disrupted HIV response activities, including partner services, outreach testing, and the operation of drop-in centers, which hindered efforts to control the outbreak.
3. Syringe Services Program (SSP) Closures: The suspension of SSPs in Kanawha County in 2018 and 2021, along with stricter legislative requirements, limited access to sterile syringes, contributing to syringe reuse and sharing among PWID.
4. High-Risk Behaviors and Substance Use: Methamphetamines and heroin were the most frequently injected drugs, with polysubstance use being common among PWID. Medical mistrust and stigma were significant barriers to care.
5. Recommendations for Improvement: Recommendations include expanding HIV and hepatitis C testing, increasing access to preexposure prophylaxis (PrEP), training service providers on stigma reduction, and enhancing care coordination through mobile services, street outreach, and telehealth.

Original Article Author and Citation

Corresponding Author

Rebecca B. Hershow, qdt8@cdc.gov, 404-718-1597

Suggested Citation

Hershow RB, Wilson S, Bonacci RA, et al. Notes from the Field: HIV Outbreak During the COVID-19 Pandemic Among Persons Who Inject Drugs — Kanawha County, West Virginia, 2019–2021. MMWR Morb Mortal Wkly Rep 2022;71:66–68. DOI: http://dx.doi.org/10.15585/mmwr.mm7102a4

Summary

During October 2019, the West Virginia Bureau for Public Health (WVBPH) identified an increase in HIV diagnoses among persons who inject drugs (PWID) in Kanawha County. The number of diagnoses rose from less than five annually during 2016–2018 to 11 in the first ten months of 2019. The COVID-19 pandemic further complicated HIV response efforts by limiting in-person services and outreach activities. The closure of syringe services programs (SSPs) in 2018 and 2021, coupled with new restrictive legislation, exacerbated the situation by reducing access to sterile syringes, leading to increased syringe reuse and sharing among PWID.

Methods

An HIV outbreak case was defined as a confirmed HIV diagnosis on or after January 1, 2019, in a PWID living in Kanawha County at the time of diagnosis. Investigators conducted qualitative interviews with 26 PWID and 45 community partners, and abstracted medical records for 65 PWID with HIV, covering 496 health care encounters from one year before HIV diagnosis through June 18, 2021. The activity was reviewed by CDC and conducted in accordance with applicable federal law and CDC policy.

Discussion

The investigation revealed that methamphetamines and heroin were the most commonly injected drugs, with polysubstance use being prevalent. PWID reported syringe reuse and sharing due to limited access to sterile syringes following SSP closures. Medical mistrust and stigma were significant barriers to care. HIV screening was performed in fewer than one-third of health care encounters before diagnosis, and none of the patients had been prescribed preexposure prophylaxis (PrEP). The COVID-19 pandemic further restricted outreach activities and access to SSPs.

Conclusion

Recommendations based on the investigation include expanding HIV and hepatitis C testing, increasing access to PrEP, training service providers on stigma reduction, and enhancing care coordination through mobile services, street outreach, and telehealth. Addressing stigma, discrimination, and low SSP access is crucial for engaging PWID in HIV prevention and treatment, especially in the context of the ongoing COVID-19 pandemic.

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