Potential geographic "hotspots" for drug-injection related transmission of HIV and HCV and for initiation into injecting drug use in New York City, 2011-2015, with implications for the current opioid epidemic in the US

• Type of Material: Article
• Authors: D.C. Des Jarlais, Icahn School of Medicine at Mount Sinai; Hannah Cooper, Emory University; K. Arasteh, Icahn School of Medicine at Mount Sinai; J. Feelemyer, Icahn School of Medicine at Mount Sinai; C. McKnight, Icahn School of Medicine at Mount Sinai; Z. Ross, ZevRoss Spatial Analysis
• Language: English
• Date: 2018-03-29
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2018 Des Jarlais et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0194799
• Title of Journal or Parent Work: PLoS ONE
• ISSN: 1932-6203
• Volume: 13
• Issue: 3
• Start Page: e0194799
• End Page: e0194799
• Grant/Funding Information: This work was supported through grant R01DA003574 from the US National Institute on Drug Abuse to DCDJ.; ZevRoss Spatial Analysis provided support in the form of salaries for author ZR but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
• Keywords: Opioids; New York; HEPATITIS-C; DEATHS; C VIRUS-INFECTION; HIV; HIV epidemiology; MANHATTAN; Spatial epidemiology; UNITED-STATES; HIV infections; INTERVENTIONS; BEHAVIORS; Multidisciplinary Sciences; Science & Technology; PEOPLE; PROGRAMS; Hepatitis C virus; HIV prevention; PREVENTION; Science & Technology - Other Topics
• Research Categories: Biology, Virology; Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

Objective We identified potential geographic “hotspots” for drug-injecting transmission of HIV and hepatitis C virus (HCV) among persons who inject drugs (PWID) in New York City. The HIV epidemic among PWID is currently in an “end of the epidemic” stage, while HCV is in a continuing, high prevalence ( > 50%) stage. Methods We recruited 910 PWID entering Mount Sinai Beth Israel substance use treatment programs from 2011–2015. Structured interviews and HIV/ HCV testing were conducted. Residential ZIP codes were used as geographic units of analysis. Potential “hotspots” for HIV and HCV transmission were defined as 1) having relatively large numbers of PWID 2) having 2 or more HIV (or HCV) seropositive PWID reporting transmission risk—passing on used syringes to others, and 3) having 2 or more HIV (or HCV) seronegative PWID reporting acquisition risk—injecting with previously used needles/syringes. Hotspots for injecting drug use initiation were defined as ZIP codes with 5 or more persons who began injecting within the previous 6 years. Results Among PWID, 96% injected heroin, 81% male, 34% White, 15% African-American, 47% Latinx, mean age 40 (SD = 10), 7% HIV seropositive, 62% HCV seropositive. Participants resided in 234 ZIP codes. No ZIP codes were identified as potential hotspots due to small numbers of HIV seropositive PWID reporting transmission risk. Four ZIP codes were identified as potential hotspots for HCV transmission. 12 ZIP codes identified as hotspots for injecting drug use initiation. Discussion For HIV, the lack of potential hotspots is further validation of widespread effecti veness of efforts to reduce injecting-related HIV transmission. Injecting-related HIV transmission is likely to be a rare, random event. HCV prevention efforts should include focus on potential hotspots for transmission and on hotspots for initiation into injecting drug use. We consider application of methods for the current opioid epidemic in the US.