• Susan E Buskin, Steven J Erly, Sara N Glick, Richard J Lechtenberg, Roxanne P Kerani, Joshua T Herbeck, Julia C Dombrowski, Amy B Bennett, Francis A Slaughter, Michael P Barry, Santiago Neme, Laura Quinnan-Hostein, Andrew Bryan, and Matthew R Golden.
• Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington; HIV/STD Program, Prevention Division, Public Health-Seattle & King County, Seattle, Washington. Electronic address: susan.buskin@kingcounty.gov.
• Am J Prev Med. 2021 Nov 1; 61 (5 Suppl 1): S160-S169.

IntroductionThe HIV epidemic in King County, Washington has traditionally been highly concentrated among men who have sex with men, and incidence has gradually declined over 2 decades. In 2018, King County experienced a geographically concentrated outbreak of HIV among heterosexual people who inject drugs.MethodsData sources to describe the 2018 outbreak and King County's response were partner services interview data, HIV case reports, syringe service program client surveys, hospital data, and data from a rapid needs assessment of homeless individuals and people who inject drugs. In 2020, the authors examined the impact of delays in molecular sequence analyses and cluster member size thresholds, for identifying genetically similar clusters, on the timing of outbreak identification.ResultsIn 2018, the health department identified a North Seattle cluster, growing to 30 people with related HIV infections diagnosed in 2008-2019. In total, 70% of cluster members were female, 77% were people who inject drugs, 87% were homeless, and 27% reported exchanging sex. Intervention activities included a rapid needs assessment, 2,485 HIV screening tests in a jail and other outreach settings, provision of 87,488 clean syringes in the outbreak area, and public communications. A lower cluster size threshold and more rapid receipt and analyses of data would have identified this outbreak 4-16 months earlier.ConclusionsThis outbreak shows the vulnerability of people who inject drugs to HIV infection, even in areas with robust syringe service programs and declining HIV epidemics. Although molecular HIV surveillance did not identify this outbreak, it may have done so with a lower threshold for defining clusters and more rapid receipt and analyses of HIV genetic sequences.Copyright © 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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