State health officials confirm cluster of 7 new HIV cases in Boston

BOSTON — State health officials have confirmed a cluster of 7 new HIV cases in Boston.

The Massachusetts Department of Public Health told Boston 25 that the newly diagnosed cases are people who inject drugs and experienced recent homelessness.

“These recently detected HIV infections follow a cluster first detected in the City in early 2019, renewing concerns about ongoing transmission in... Massachusetts,” the state health agency said in a statement Wednesday.

Between 2000 and 2014, the number of reported HIV infections in Massachusetts declined by 47 percent overall and by 91 percent among people who inject drugs, the DPH said. However, starting in 2015 this trend reversed presumably as a result of the opioid epidemic and the widespread introduction of fentanyl into the illicit drug supply.

Between 2016 and 2018, a large outbreak of HIV infection occurred in Lawrence and Lowell, with most of these cases among people who inject drugs who were also experiencing homelessness, the DPH said.

“Active drug use, homelessness, and for some, periods of incarceration create significant challenges to screening for HIV infection and continuous treatment of HIV infection,” the agency said. “It is important that diagnosis of infection is made early and treatment initiated early, both for the health of the individual and to prevent onward transmission of HIV infection.”

State health officials are calling for healthcare providers to boost vigilance for HIV risk, increase testing for HIV infection, and to rapidly report any new HIV infections to the state.

Here is some additional information on HIV concerns:

Statewide

• In 2019, Massachusetts saw a dramatic decrease in new HIV cases among people who inject drugs (PWID). As of Jan. 1, 2020, only 52 people were diagnosed with HIV who had injection drug use as a risk behavior last year. While 2019 cases are likely to continue to be reported, previous increases in HIV among PWID seen since 2014 (when only 60 of these cases were diagnosed) appear to have abated.
• In 2017, the figure was 140; and in 2018 it was 112.

Boston

• DPH has been working with the Boston Public Health Commission to investigate a cluster of HIV cases among people who inject drugs and/or experience homelessness that are linked to Boston, including people who may reside outside of the city but were diagnosed or seen at a Boston facility.
• Between December 2018 and December 2019, 25 cases have been linked to this Boston cluster, including these 7 new cases.
• In 2019, 14 Boston residents whose risk included injection drug use were diagnosed. (They’re included in the 25).

State efforts undertaken to get ahead of these outbreaks

• DPH has expanded state-funded Syringe Services Programs (SSPs) to 33 statewide from five in 2015 and are increasing the clinical (nursing) capacity of existing programs to provide a broader range of health services (e.g. wound care, immunizations)
• Building on the experience of responding to the recent HIV outbreak in Lowell and Lawrence, the state has implemented molecular HIV surveillance statewide, which allows DPH disease investigators to link cases from different parts of the state by looking at the similarities in their genetics of their HIV, allowing us to better understand patterns of transmission and the full scope of detected outbreaks.
• We have doubled our field epidemiologist team which reaches out to all newly diagnosed people with HIV as well as those who have fallen out of care, to link them to care and help their partners get tested. The team’s size grew from nine epis in in 2018 to 18 field epis today. A number of these epis are outposted to high-volume clinical sites to assist with care linkage and partner services.
• DPH is actively detecting and responding to even small outbreaks of HIV among people who inject drugs and/or experience homelessness because of the potential for onward transmission of HIV. DPH, local health departments and funded providers are working collaboratively to link people to care, harm reduction services, and other needed social services.

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