Response to a Large HIV Outbreak, Cabell County, West Virginia, 2018-2019

Area of Science:

• Public Health
• Epidemiology
• Infectious Disease

Background:

• An HIV outbreak was detected among people who inject drugs in Cabell County, West Virginia, in January 2019.
• The response aligned with the Ending the HIV Epidemic in the U.S. initiative's pillars: Diagnose, Treat, and Prevent.

Purpose of the Study:

• To describe the design and implementation of a comprehensive HIV outbreak response in Cabell County.
• To analyze HIV transmission dynamics and the impact of interventions.

Main Methods:

• Utilized West Virginia Bureau for Public Health surveillance data from January 2018 to October 2019.
• Analyzed HIV-1 polymerase sequences using molecular clock phylogenetic analysis to estimate transmission rates and timing.
• Documented the implementation of interventions by federal, state, and local partners.

Main Results:

• Identified 82 individuals in the outbreak; 93% of transmissions in a major cluster occurred after January 1, 2018.
• The outbreak primarily affected males (60%) and White individuals (91%), with 80% reporting unstable housing.
• Expanded HIV testing, pre-exposure prophylaxis (PrEP), and syringe services led to improved linkage to care and viral suppression.

Conclusions:

• Rapid HIV transmission necessitated a strong, collaborative response among multiple agencies.
• The comprehensive interventions significantly improved HIV prevention and care services.
• Effective HIV outbreak response demands enhanced coordination and innovative service delivery for affected populations.