APHL workshop advances integration of HIV, HCV and syphilis testing

Attendees of the testing algorithms pre-HIV Diagnostic Conference workshop listen to a presentation.

Integrating HIV, hepatitis C virus (HCV) and syphilis testing is a laboratory best practice that improves detection of common co-infections and expedites treatment, but integrating these tests is not always easy. Each health department is unique, so they must take a customized approach to implementation based on their distinct set of requirements. To succeed, a health department and its public health laboratory must share common goals and be willing to work together to forge a mutually acceptable agreement.

Until recently, laboratories aiming for test integration had no venue to discuss the practical issues involved. This changed in 2019 when APHL sponsored a one-day workshop prior to the HIV Diagnostics Conference to review HIV, HCV and syphilis testing algorithms; discuss diagnostic testing challenges for each of the three pathogens; and compare recommended methods and protocols to those in use at attendees’ laboratories.

Modeled upon similar APHL workshops for influenza, the workshop brought together representatives from 20 states, the three CDC divisions that funded the workshop and professionals from related areas of public health. Participants exchanged information on common issues such as educating providers and submitters about HIV and syphilis algorithms, appropriate use of nucleic acid testing (NAT) for confirmation of HIV infection, access to ribonucleic acid (RNA) testing for confirmation of HIV and HCV infection, and selection of the optimal syphilis algorithm. Participants like Mary Louise Walmsley, MT(ASCP)—a public health microbiologist in the Alaska State Virology Laboratory’s Department of Immunology—were enthusiastic about the workshop: “Because of the workshop, new and pertinent information regarding HCV and syphilis will be incorporated into the programs at our facility. This was a fantastic workshop, and I hope APHL hosts another one.”

Pending available funding, APHL hopes to continue to sponsor this workshop at future conferences, with a possible return to the HIV Diagnostics Conference, which is held every two to three years. However, given this interval between conferences, APHL is also exploring options at conferences of partner organizations whose work relates to HIV, HCV and STD testing.

In related efforts, APHL has urged the US Department of Health and Human Services (HHS) to develop an STD Federal Action Plan that aligns with other HHS initiatives to combat overlapping epidemics. Additionally, APHL is supporting the Ending the HIV Epidemic plan and efforts to eliminate HCV.

The post APHL workshop advances integration of HIV, HCV and syphilis testing appeared first on APHL Lab Blog.

APHL workshop advances integration of HIV, HCV and syphilis testing

Attendees of the testing algorithms pre-HIV Diagnostic Conference workshop listen to a presentation.

Integrating HIV, hepatitis C virus (HCV) and syphilis testing is a laboratory best practice that improves detection of common co-infections and expedites treatment, but integrating these tests is not always easy. Each health department is unique, so they must take a customized approach to implementation based on their distinct set of requirements. To succeed, a health department and its public health laboratory must share common goals and be willing to work together to forge a mutually acceptable agreement.

Until recently, laboratories aiming for test integration had no venue to discuss the practical issues involved. This changed in 2019 when APHL sponsored a one-day workshop prior to the HIV Diagnostics Conference to review HIV, HCV and syphilis testing algorithms; discuss diagnostic testing challenges for each of the three pathogens; and compare recommended methods and protocols to those in use at attendees’ laboratories.

Modeled upon similar APHL workshops for influenza, the workshop brought together representatives from 20 states, the three CDC divisions that funded the workshop and professionals from related areas of public health. Participants exchanged information on common issues such as educating providers and submitters about HIV and syphilis algorithms, appropriate use of nucleic acid testing (NAT) for confirmation of HIV infection, access to ribonucleic acid (RNA) testing for confirmation of HIV and HCV infection, and selection of the optimal syphilis algorithm. Participants like Mary Louise Walmsley, MT(ASCP)—a public health microbiologist in the Alaska State Virology Laboratory’s Department of Immunology—were enthusiastic about the workshop: “Because of the workshop, new and pertinent information regarding HCV and syphilis will be incorporated into the programs at our facility. This was a fantastic workshop, and I hope APHL hosts another one.”

Pending available funding, APHL hopes to continue to sponsor this workshop at future conferences, with a possible return to the HIV Diagnostics Conference, which is held every two to three years. However, given this interval between conferences, APHL is also exploring options at conferences of partner organizations whose work relates to HIV, HCV and STD testing.

In related efforts, APHL has urged the US Department of Health and Human Services (HHS) to develop an STD Federal Action Plan that aligns with other HHS initiatives to combat overlapping epidemics. Additionally, APHL is supporting the Ending the HIV Epidemic plan and efforts to eliminate HCV.

The post APHL workshop advances integration of HIV, HCV and syphilis testing appeared first on APHL Lab Blog.

The Anatomy of an HIV Outbreak Response in a Rural Community

Drug abuse with people sharing the same syringe to inject heroine

In a small, rural town in Southern Indiana, a public health crisis emerges.  In a community that normally sees fewer than five new HIV diagnoses a year, more than a hundred new cases are diagnosed and almost all are coinfected with hepatitis C virus (HCV).

How was this outbreak discovered, and what caused this widespread transmission? Indiana state and local public health officials – supported by CDC – set out to answers these questions and help stop the spread of HIV and HCV in this community.

The Outbreak

In January 2015, Indiana disease intervention specialists noticed that 11 new HIV diagnoses were all linked to the same rural community.  This spike in HIV diagnoses in an area never before considered high-risk for the spread of HIV, launched a larger investigation into the cause and impact of these related cases.

The investigation began by investigating the 11 newly diagnosed cases. This process involved talking to newly diagnosed individuals about their health and sexual behaviors, as well as past drug use. In the United States, HIV is spread mainly by having sex or sharing injection drug equipment such as needles with someone who has HIV.

Scanning electron micrograph of HIV-1 virions budding from a cultured lymphocyte.
Scanning electron micrograph of HIV-1 virions budding from a cultured lymphocyte.

In the case of the 11 related diagnoses in Indiana, almost all were linked to injection drug use. Investigators discovered that syringe-sharing was a common practice in this community–often used to inject the prescription Opana; opioid oxymorphone (a powerful oral semi-synthetic opioid medicine used for pain.)  HIV can be spread through injection drug use when injection drug equipment, such as syringes, cookers (bottle caps, spoons, or other containers), or cottons (pieces of cotton or cigarette filters used to filter out particles that could block the needle) are contaminated with HIV-infected blood. The most common cause of HIV transmission from injection drug use is syringe-sharing. Persons who inject drugs (PWID) are also at risk for HCV infection. Co-infection with HCV is common among HIV-infected PWID. Between 50-90% of all persons who inject drugs are infected with both HIV and HCV.

The Investigation

“Contact tracing” is the process of identifying all individuals who may have potentially been exposed to an ill person, in this case a person infected with HIV.  Contact tracing involves interviewing the newly diagnosed patients to identify their syringe-sharing and sex partners.  These “contacts” are then tested for HIV and HCV infection, and if found infected are likewise interviewed to identify their syringe-sharing and sex partners. This cycle continues until no more new contacts are located.

As of May 18, contract tracing and increased HIV testing efforts throughout the community identified 155 adult and adolescent HIV infections. The investigation has revealed  that injection drug use in this community is a multi-generational activity, with as many as three generations of a family and multiple community members injecting together and that due to the short half-life of the drug, persons who inject drugs may have injected multiple times per day (up to 10 in one case). may be needed .

Early HIV treatment not only helps people live longer but it also dramatically reduces the chance of transmitting the virus to others.  People who do not have HIV and who are at high risk for HIV can also benefit more directly from the drugs used to treat HIV to prevent them from acquiring HIV.  This is known as pre-exposure prophylaxis (PrEP). Post-exposure prophylaxis, or PEP, is an option for those who do not have HIV but could have been potentially exposed in a single event.

The Response

HIVTesting_Eng_webSo what is the next step in addressing this staggering outbreak? First, public health officials must work to get every person exposed to HIV tested. All persons diagnosed with HIV need to be linked to healthcare and treated with antiretroviral medication. Persons not infected with HIV are counseled on effective prevention and risk reduction methods; including condom use, PrEP, PEP, harm reduction, and substance abuse treatment. Getting messages about the benefits of HIV treatment to newly diagnosed individuals and prevention information to at-risk members of the community are key components to control this outbreak.

The underlying factors of the Indiana outbreak are not completely unique. Across the United States, many communities are dealing with increases in injection drug use and HCV infections; these communities are vulnerable to experiencing similar HIV outbreaks. CDC asked state health departments to monitor data from a variety of sources to identify jurisdictions that, like this county in Indiana, may be at risk of an IDU-related HIV outbreak.  These data include drug arrest records, overdose deaths, opioid sales and prescriptions, availability of insurance, emergency medical services, and social and demographic data. Although CDC has not seen evidence of another similar HIV outbreak, the agency issued a health alert to state, local, and territorial health departments urging them to examine their HIV and HCV surveillance data and to ensure prevention and care services are available for people living with HIV and/or HCV.

The work that has been done thus far, as well as the continued efforts being made to address this response, highlight importance of partnerships between federal, state and local health agencies. The work done by Indiana State Department of Health’s disease intervention specialist to link the initial HIV cases to this rural community, and the work of the local health officials to respond quickly and thoroughly to investigate all possible exposures and spread important health prevention information demonstrates the critical importance of strong public health surveillance and response.

The Division of HIV/AIDS Prevention commends the efforts of all the individuals involved in controlling the HIV outbreak in Indiana. The response illustrates that together we are committed to improving the health of our communities across the nation.

 

 

 

New Miracle Drugs: What Would You Pay?

Levi Collazo, a biology major at Southwestern Oklahoma State University, has cystic fibrosis (CF). “In the first photo, I was making fun of my own weight. I’ve always used humor as a defense mechanism. I weighed 110 pounds. I’m 5’10″. … Continue reading »

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Supporting Hepatitis Awareness with Open Access Hepatitis Research

World Hepatitis Day was July 28th, and PLOS ONE is observing the day by raising awareness with a few of our many open access articles on viral hepatitis that we’ve published in the past year. According to the …

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Coalescent inference for infectious disease

Today my student Bethany Dearlove has her first paper published, called Coalescent inference for infectious disease: meta-analysis of hepatitis C. In this paper, published in Philosophical Transactions of the Royal Society B, we have developed coalescent-based population genetics methods for popular, deterministic, epidemiological models known as SI (susceptible-infectious), SIS (susceptible-infectious-susceptible) and SIR (susceptible-infectious-recovered). By implementing these methods in BEAST, we were able to re-analyse previously published hepatitis C virus datasets and directly estimate epidemiological parameters. Our results show that, in the absence of co-infection, the widely-used exponential growth and logistic growth models of changing population size correspond directly to SI and SIS dynamics. We were also able to examine the limitations to genetic approaches to reconstructing epidemiological dynamics.

This paper appears as part of an issue on Next-generation molecular and evolutionary epidemiology of infectious disease, which accompanies a Royal Society discussion meeting organized by Oli Pybus, Christophe Fraser and Andrew Rambaut. The Royal Society has made audio recordings of the talks at this meeting, and the accompanying satellite meeting, available online, including my talk on Bethany's paper.

James Martin Fellowship

This position is now closed. A prestigious James Martin Fellowship funded by the Oxford Martin School is available in my research group for a highly motivated and creative population geneticist interested in developing cutting edge methods for the analysis of high-throughput whole genome sequencing data to better understand the evolution and epidemiology of the major pathogens HIV and Hepatitis C Virus.

The position, which is part of the Curing Chronic Viral Infections project, is fully funded for three years and is affiliated with the Institute for Emerging Infections, the Modernising Medical Microbiology consortium, the Peter Medawar Building for Pathogen Research and the Nuffield Department of Medicine. The ideal candidate will have a track record in statistical or computational genetics and experience of programming in a language such as C++ or Java.

Full details can be found on the University of Oxford Recruitment website. Please send informal enquiries, with a CV, to me by email. The deadline for applications is 12 noon on 27th November 2012.

Post-doc Positions in Pathogen Genomics

Post-doc positions in Pathogen Genomics are available in my group and Derrick Crook's lab. We will be hiring people to work on pathogen whole genome sequence analysis and bioinformatics. More details available soon. In the meantime, find out about our research:
If you are interested, please get in touch.