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Respond quickly to potential outbreaks to get prevention and treatment services to people who need them

The strategic use of cutting-edge, data-driven, collaborative, evidence-based approaches to diagnosing, treating, and preventing HIV/HCV reduces the likelihood of an outbreak and increases the capacity for a swift and effective response, should an outbreak occur. State and local public health stakeholders must plan for an outbreak response, cooperate on detection efforts, and collaborate to ensure that the necessary tools, supports, and services are deployed to resolve outbreaks as quickly as possible.[1]

Preparedness includes ensuring that the resources and policies that undergird HIV and HCV prevention and intervention reflect current public health guidance and recommendations, including sound testing approaches with contact tracing and partner services, accessible treatment services, evidence-based prevention strategies (including access to PrEP and harm reduction services), an interconnected network of health and social services providers, and meaningful engagement of PLHIV/PLHCV and those at increased risk. Timely detection of an HIV or HCV outbreak depends on a robust surveillance system that includes routine and ongoing HIV and HCV case surveillance data, identification of unexpected patterns in contact tracing investigations and partner services, analysis of molecular HIV surveillance data to identify clusters of closely related cases, and observation and communication by healthcare providers, health department staff, and community members.

In the event that an outbreak occurs, local, regional, and state-level healthcare and public health agencies must coordinate efforts with partners rooted in the community to ensure that all necessary tools, resources, supports, and services are available to assist people who are newly diagnosed with HIV and/or HCV and to prevent additional transmission. These approaches depend on the leadership and ongoing communication of public health experts and governmental leaders, in collaboration with diverse partners and stakeholders – including PLHIV/PLHCV and those at increased risk.

Much of what is known about effective response is based on lessons learned during the 2015 HIV outbreak in Scott County, Indiana. Initially detected through clinical observation, this rural community saw 235 residents diagnosed with HIV over the course of the outbreak. The primary driver of the outbreak was the opioid epidemic, which swept through a community that lacked many of the proven prevention tools, as well as some critical diagnostic and treatment resources.[2] By the late summer of 2015, state and local public health authorities and a diverse array of community partners were able to deploy many of the supports and services necessary to curb the outbreak, including establishing an SSP and creating a “one-stop shop” where people could get harm reduction materials, drug treatment referrals, free HIV and HCV testing, contact tracing, health insurance navigation, care coordination, PrEP, HIV treatment, and access to social services through various community- and faith-based partners.[3]

The 2015 HIV outbreak in Scott County showed the world how quickly HIV incidence rates can climb in tight-knit communities gripped by the opioid epidemic and is often used as a case study for HIV and HCV outbreak response. The following objectives and strategies incorporate recommended approaches for ensuring effective preparation for, detection of, and response to HIV and HCV outbreaks, based on current evidence-informed guidance and stakeholder-identified priorities and interests. Among the hundreds of Hoosiers who contributed to the development of this plan were people who were involved in the response to the HIV outbreak in Scott County. For them, as for all of us, the Scott County HIV outbreak is not just a theoretical framework for debate, but instead presents the opportunity to learn about and reflect on the lives and experiences of hundreds of people, and to identify the ways in which we may care for one another to support health and wellbeing for all.

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[1] Ungar. L. (2020). 5 Years After Indiana's Historic HIV Outbreak, Many Rural Places Remain At Risk. Retrieved from  https://www.npr.org/sections/health-shots/2020/02/16/801720966/5-years-after-indianas-historic-hiv-outbreak-many-rural-places-remain-at-risk

[2] Janowicz D. M. (2016). HIV Transmission and Injection Drug Use: Lessons From the Indiana Outbreak. Topics in antiviral medicine, 24(2), 90–92.

[3] Centers for Disease Control and Prevention. (2018) Managing HIV and Hepatitis C Outbreaks Among People Who Inject Drugs- A Guide for State and Local Health Departments. Retrieved from https://www.cdc.gov/hiv/pdf/programresources/guidance/cluster-outbreak/cdc-hiv-hcv-pwid-guide.pdf