PETER HARTSOCK
$371,875
Vanderbilt University Medical Center
Tennessee
National Institute on Drug Abuse (NIDA)
/ Abstract The HIV, HCV, and opioid epidemics disparately impact populations in different regions of the US, with higher burden (51% of new HIV diagnoses in the US) and poorer outcomes (highest HIV mortality in the US, at 6-10 per 1,000 persons with HIV) in the South, particularly largely rural states. Southern states also rank among those with the highest rates of acute and chronic Hepatitis C virus (HCV), with massive increases in HCV infections due to injected opioid use in Tennessee, Kentucky, Virginia, and West Virginia between 2006 and 2012 (from 1 to nearly 4 per 100,000). The region has also seen a dramatic increase in overdose mortality during the COVID-19 pandemic (West Virginia and Tennessee ranked 1st and 3rd in the US, respectively, with ≥50 deaths per 100,000), with opioid abuse a continued driver of the regional HIV/HCV syndemic. With the relatively recent HIV/HCV outbreak in Scott County, Indiana in mind, the CDC assessed county-level vulnerabilities to an HIV outbreak based on acute HCV infection. Acute HCV infection was used as a proxy of high HIV risk due to the proximal cause of shared injection drug use, an increasingly common practice in areas afflicted with high rates of opioid use and overdose. The research directly informed the initiation of the Tennessee Prescription Drug Overdose Program, a CDC-funded surveillance system to monitor both fatal and non-fatal drug overdoses. Reporting requirements have also been revamped and a new informatics infrastructure has been created to accommodate automated laboratory uploads of viral hepatide antibody, antigen, and nucleic acid testing to ascertain acute HCV infection, alongside the state’s already robust HIV surveillance program. Similar programs now exist in 32 states. In addition, over the past several years, syringe service programs and expanded access to non-prescription naloxone were made legal under Public Chapters 413 and 596 in Tennessee, while the state’s “fetal assault” law, along with similar ones in Alabama and South Carolina, penalized expectant mothers with opioid addictions until recently. The proposed research will therefore harmonize, link, and analyze readily available “big data” sources to enhance the epidemiology of HIV, HIV/HCV co-infection, and opioid overdose mortality outcomes which will inform HIV/HCV and overdose prevention and treatment activities by improving the targeting of highest- risk/highest-reward populations for their receipt (Aims 1 and 2). Assessing the impact of individual behavior and environmental context (neighborhood characteristics such as structural poverty and disorder, lack of transportation, etc.) as well as policy changes on these outcomes will be an essential addition to the literature, and as importantly, to data dissemination platforms (e.g., dashboards) which will improve deployment of prevention and treatment activities in southern states (Aims 1, 2, and 3). Using epidemiologic research to inform policy, while creating dissemination platforms which may be updated and re-deployed in future for regional pandemic preparedness, means this work will remain a valuable resource for years to come.