Vancouver AIDS experts respond to HIV outbreak in rural Indiana

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      The B.C. Centre for Excellence in HIV/AIDS (BC-CfE) is taking its expertise to rural U.S.A.

      Joining forces with the Indiana University School of Medicine, the centre is helping respond to a highly concentrated HIV epidemic driven by the injection of prescription opioids in Austin, Indiana.

      With an estimated population of 4,200, Austin is located in the state’s Scott County. Approximately 10 percent of its population injects opioids on a daily basis. More than 184 new HIV cases have been identified since December 2015—the worst outbreak in state history.

      The joint effort allows the BC-Cfe to apply its HIV Treatment as Prevention model to the rural setting.

      Although neither a cure nor a vaccine for HIV/ AIDS exists, several advances in HIV treatment have been achieved over the past two decades. Most significant among them was the development of highly active antiretroviral therapy (HAART), a combination of antiretroviral drugs that can fully suppress HIV replication. It therefore renders the number of viral copies present in a patient’s blood undetectable.

      Shortly after the initial roll out of HAART in 1996, data from Taiwan and British Columbia suggested that new HIV diagnoses had unexpectedly decreased. Most intriguingly, in British Columbia, the effect of HAART on new cases was apparent despite a steady rise in syphilis rates. The data suggested that HAART could be much more effective in reducing HIV transmission than previously suspected.

      "We have a chance to reverse the course of this HIV epidemic by implementing fast-acting and effective evidence-based strategies,” Dr. Kara Wools-Kaloustian, associate professor of medicine and director of the division of infectious diseases at the IU School of Medicine, said in a news release. “Using innovations in science and technology, as well as targeted and compassionate approaches to reach those affected by this outbreak, this has the potential to decrease HIV transmission and help save lives within the state of Indiana.”

      The international team aims to identify factors that affect whether individuals seek and continue with HIV treatment. Researchers will also investigate how to counter the public-health harms of injection drug use through the expansion of harm-reduction services and other programs.

      "Treatment as Prevention has been implemented across diverse international jurisdictions from China to Panama to major cities within the United States," said Dr. Julio Montaner, director of the BC Centre for Excellence in HIV/AIDS, who will be coleading the research. "The situation in Indiana marks a critical need for implementing best practices in harm reduction and HIV prevention. Treatment as Prevention® is a model for opening up access to early HIV treatment and care, for reducing stigma, and for targeted disease elimination.

      "Providing sustained, consistent treatment and care ensures that an individual’s viral load decreases, dramatically reducing the likelihood of disease progression and secondarily stopping HIV transmission,” he added.

      The National Institute on Drug Abuse is supporting the effort with a two-year, $200,000 grant, with additional funding coming from the school of medicine's department of medicine.

      “This is an excellent opportunity to expand the successful scientific model implemented within British Columbia and create public health programs that can save lives, applying lessons learned to a growing prescription opioid addiction and drug use problem,” said Jacques Normand, director of AIDS Research at the National Institute on Drug Abuse. 

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