Predict, Detect, Diagnose: Confronting Outbreaks of HIV and Other Infectious Diseases Among People Who Use Drugs

Thomas M. Menino Convention & Exhibition Center 

People who use drugs (PWUD) are among the most stigmatized populations in the United States and around the world, which has compromised their health and well-being. Making matters worse, there have been over a dozen outbreaks of human immunodeficiency virus (HIV) among people who use drugs since a well-publicized outbreak in Scott County, Indiana in 2015. Fueled by the ongoing opioid epidemic, along with methamphetamine use, these continual flare-ups fit a pattern of resurgence in a host of drug-related conditions, including infections with hepatitis C virus (HCV), skin and soft tissue infections (SSTI), sexually transmitted infections (STI), and infective endocarditis (IE). Recognizing that no single approach will be sufficient to prevent or contain the "converging public health crisis" of substance use and infectious disease—working in collaboration with over a dozen state and municipal health agencies—we are developing an integrated set of mutually complementary strategies to address drug-related HIV outbreaks at three different stages of their life cycle—before they emerge in high risk locales, at the early stages of their emergence, and once they have been established in a community. Using methods from statistics, decision-science, epidemiology and operations research we are working towards: developing an "early warning" algorithm to predict rises in local HIV cases among PWUD; refining algorithms that minimize both time to outbreak detection and the risk of false alarms; improving case-finding algorithms to more quickly diagnose patients and contain outbreaks in progress. While our immediate focus is on prediction, detection, and diagnosis of previously undiagnosed cases and containment of HIV outbreaks among PWUD, the tools we are designing and evaluating will be applicable to a much broader range of infectious diseases and vulnerable demographic groups.