HIV Outbreak: Community-Based Interventions’ Impact

Researchers at the University of Bristol have shown that community-based testing and treatment in response to the HIV epidemic among persons who inject drugs (PWID) in Glasgow effectively contained the outbreak in 2015. The results of the study, which were published in the Journal of Infectious Diseases (JID), show that if these treatments hadn’t been put in place, the number of infections by 2020 would have been about three times higher.

The researchers also demonstrated how early HIV testing and treatment advancements may have further limited the scope of the pandemic. It may have been completely avoided if HIV testing and treatment had been optimized before the pandemic was identified.

The research was conducted in association with Public Health Scotland and NHS Greater Glasgow & Clyde (GGC) after the discovery of an HIV outbreak in the PWID GGC area of Scotland in 2015.

PWID are more likely to contract blood-borne infections like HIV if they share syringes and needles. Usually, the use of opioid agonist treatment and needle exchange programs stops blood-borne diseases like HIV from spreading among PWID. Nevertheless, even though these applications were widely accessible, the Glasgow pandemic still happened.

By the end of 2019, there had been more than 150 diagnoses. To address the outbreak, a multi-service approach was taken to increase HIV testing and treatment. The Glasgow Enhanced HIV Care Outreach (GECHO) service model modification resulted in gains in treatment, with the average time from HIV diagnosis to treatment initiation decreasing from 264 days in 2015 to 23 days in 2019.

GECHO represents a shift in the way this significant subset of HIV-positive individuals receives care. Understanding the effect of testing and treatment treatments, such as GECHO, on the outbreak was the goal of the modeling study.

Lara Allen, Ph.D. student at the Bristol Medical School and corresponding author, said, “Our study suggests that a community-based approach to HIV testing and treatment could be hugely beneficial for managing emerging HIV outbreaks among PWID. I hope our findings lead to the development of more programs that reduce blood-borne virus transmission among PWID by considering the wider needs of the population.”

Lara Allen, Ph.D. student at the Bristol Medical School and corresponding author, said, “Our study suggests that a community-based approach to HIV testing and treatment could be hugely beneficial for managing emerging HIV outbreaks among PWID. I hope our findings lead to the development of more programs that reduce blood-borne virus transmission among PWID by considering the wider needs of the population.”

Matthew Hickman, Professor in Public Health and Epidemiology at Bristol Medical School: Population Health Sciences (PHS) and joint senior author, added, “These findings support the use of ‘treatment as prevention’ (TasP) interventions for responding to HIV outbreaks among PWID. The study also highlights the importance of a combined approach, as improvements in either testing or treatment alone would not have controlled the outbreak. Our analysis suggests that HIV testing and treatment interventions should be maintained even when HIV appears to be endemically low, as had been the case before the outbreak in Glasgow.”

Dr. Erica Peters, Clinical Lead for GECHO in NHS GGC, noted, “It is valuable to have had this academic collaboration led by the University of Bristol with our clinical team here in Glasgow. Evaluating our GECHO care model in a population largely excluded from standard pathways of care has demonstrated the effectiveness of the challenging, but rewarding, work that our nursing and medical team deliver to some of our most vulnerable patients.”

“However, given the financial pressures faced by the health care system, the NHS GGC team is keen in future to understand the cost-effectiveness of the testing and treatment interventions as the outbreak comes under control.”

Building on this work, Bristol researchers intend to employ modeling to comprehend variables influencing treatment outcomes as preventive treatments in the early phases of HIV outbreaks among PWID in general.

For more information: Testing and Treatment Interventions in Community Settings Key to Controlling a Recent Human Immunodeficiency Virus Outbreak Among People Who Inject Drugs in Glasgow: A Modeling Study, The Journal of Infectious Diseases,  https://doi.org/10.1093/infdis/jiae206