An emergency syringe exchange
program implemented after an outbreak of HIV earlier this year in the state of
Indiana led to a decrease in risk behaviours including needle sharing during
its first five months, researchers reported at IDWeek 2015 this month in San
Diego. These findings add to the evidence that needle exchange is an effective
harm reduction intervention for people who inject drugs.
In January 2015 the Indiana State
Department of Health, later joined by the U.S. Centers for Disease Control and
Prevention (CDC), began investigating an outbreak of HIV after disease
intervention specialists confirmed nearly a dozen new infections in a rural
community in Scott County. The CDC issued an official health
advisory about the outbreak in April and CDC and
Indiana investigators published a report
in the May
1 edition of Morbidity and Mortality
Weekly Report.
Investigators traced the new HIV
infections – as well as hepatitis C virus (HCV) infections – to people who
inject oxymorphone (brand name Opana),
a prescription opioid painkiller.
At the International AIDS Society
conference this summer John Brooks from the CDC's HIV Epidemiology Team described efforts
to determine the source of the outbreak, trace patterns of transmission, halt
further infections and bring affected people into care.
Monita
Patel of the CDC presented a report – selected as an IDWeek featured
abstract – on an emergency syringe exchange program implemented
on April 6 in response to the outbreak, after Indiana Governor Mike Pence declared a public health emergency
on March 26 allowing local governments to establish otherwise-illegal needle
exchanges.
Investigators with the CDC, Scott County Department
of Health and Indiana State Department of Health looked at changes in
injection-related risk behaviour over time.
At each exchange visit clients received sterile
syringes, a wound kit, harm reduction education and referrals to health and
substance abuse services, and were surveyed about their current risk behaviours.
To date the
outbreak has involved 181 new HIV infections, with the last seen in late
August, according to Patel. Researchers estimate that there are more than 500
people who inject drugs in Scott County. As noted in the earlier reports, injection
drug use in this community is often multi-generational, and family and
community members frequently inject together and share syringes and other
equipment.
The researchers analysed data from 148 participants
(62% of all exchange clients) who made more than two exchange visits at least seven
days apart through August 30. More than half (56%) were men, almost all were
white and heterosexual, and the median age was 34 years. While 89% reported
injecting oxymorphone, just 17% said they injected
heroin.
These participants together made 854 visits, with a median
of four visits per person, or 0.58 visits per week. The median interval between
the first and the most recent visit was 10 weeks.
Based on client self-reports, sharing syringes
declined significantly, from 18% at the first visit to 2% at the most recent
visit. Participants also reported declines in sharing syringes to divide drugs
(from 19% to 4%) and sharing other injection equipment such as spoons and
filters (from 24% to 5%). The frequency of a single person reusing the same
syringe declined significantly, from two uses to one use.
There were significant increases in the number of
syringes per person distributed (from 35 to 63) and returned (from 0 to 57),
associated with a rise in the daily frequency of injection from five to nine
times a day.
"Emergency needle
exchange was necessary, feasible, and successful," the researchers
concluded. They added that complementary HIV prevention interventions are also
essential, including pre-exposure prophylaxis (PrEP) and antiretroviral therapy
for people found to be HIV-positive (treatment as prevention).