• R Paul McClung, Amy D Atkins, Michael Kilkenny, Kyle T Bernstein, Kara S Willenburg, Matthew Weimer, Susan Robilotto, Nivedha Panneer, Erica Thomasson, Elizabeth Adkins, Sheryl B Lyss, Shawn Balleydier, Anita Edwards, Mi Chen, Suzanne Wilson, Senad Handanagic, Vicki Hogan, Meg Watson, Scott Eubank, Carolyn Wright, Antoine Thompson, Elizabeth DiNenno, FanfairRobyn NeblettRNDivision of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia; U.S. Public Health Service Commissioned Corps, Atlanta, Georgi, Alison Ridpath, Alexandra M Oster, and 2019 Cabell County HIV Outbreak Response Team.
• Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia; U.S. Public Health Service Commissioned Corps, Atlanta, Georgia. Electronic address: rmcclung@cdc.gov.
• Am J Prev Med. 2021 Nov 1; 61 (5 Suppl 1): S143-S150.

IntroductionIn January 2019, the West Virginia Bureau for Public Health detected increased HIV diagnoses among people who inject drugs in Cabell County. Responding to HIV clusters and outbreaks is 1 of the 4 pillars of the Ending the HIV Epidemic in the U.S. initiative and requires activities from the Diagnose, Treat, and Prevent pillars. This article describes the design and implementation of a comprehensive response, featuring interventions from all pillars.MethodsThis study used West Virginia Bureau for Public Health data to identify HIV diagnoses during January 1, 2018-October 9, 2019 among (1) people who inject drugs linked to Cabell County, (2) their sex or injecting partners, or (3) others with an HIV sequence linked to Cabell County people who inject drugs. Surveillance data, including HIV-1 polymerase sequences, were analyzed to estimate the transmission rate and timing of infections using molecular clock phylogenetic analysis. Federal, state, and local partners designed and implemented a comprehensive response during January 2019-October 2019.ResultsOf 82 people identified in the outbreak, most were male (60%), were White (91%), and reported unstable housing (80%). In a large molecular cluster containing 56 of 60 (93%) available sequences, 93% of inferred transmissions occurred after January 1, 2018. HIV testing, HIV pre-exposure prophylaxis, and syringe services were rapidly expanded, leading to improved linkage to HIV care and viral suppression.ConclusionsEvidence of rapid transmission in this outbreak galvanized robust collaboration among federal, state, and local partners, leading to critical improvements in HIV prevention and care services. HIV outbreak response requires increased coordination and creativity to improve service delivery to people affected by rapid HIV transmission.Published by Elsevier Inc.

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