B.C. and Indiana doctors team up to confront HIV outbreak

Doctors in British Columbia who pioneered an HIV prevention strategy are now helping to curb what an Indiana doctor calls the largest HIV outbreak in a rural setting in the U.S.

Austin, Indiana has 4,200 residents and about 10 per cent inject narcotics. Nearly 10 per cent also live below the federal poverty line. 

The town has one set of traffic lights and a single high school. Since last year, 184 new HIV infections have been identified in Scott County, about 48 kilometers north of Louisville, Ky.

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"There's a tight network of people who have a large number of needle sharing partners," said Dr. Diane Janowicz, an infectious disease specialist at the University of Indiana in Indianapolis. "On average eight,  but that ranges anywhere from only a couple but up to 20 needle-sharing partners."

Janowicz and the university turned to the BC Centre for Excellence in HIV/AIDS for help. The Centre's Treatment as Prevention Strategy is credited with a 65 per cent decline in new HIV cases since 1994 and has been adopted internationally.

Through a grant from the National Institute on Drug Abuse, researchers plan to use satellite-based mapping technology to seek out users, test and treat with antiretrovirals — including those at high risk of infection in Austin and surrounding five counties.

Health officials in Indiana need to act urgently to find out exactly why it's happening, said Dr. Julio Montaner, director of the BC Centre for Excellence in HIV/AIDS.

"By denying them access to clean supplies, what you're doing virtually is pushing these people in the alleys and  to the hidden corners of  society where they cannot  be adequately reached by  health services," Montaner said.

Currently, the town's safe injection site is stretched to its limit and staff at the clinic face an influx of people needing medical, psychiatric and rehabilitative care, Janowicz said.

Last March, Governor Mike Pence declared a public health emergency in Scott County to provide more resources and tools for the outbreak.  

Investigators plan to have the program up and running in the next two months. They hope to optimize the B.C. model for the rural setting and understand what factors influence patients during each step.