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Principal Investigator: Gregg Steven Gonsalves
Organization: YALE UNIVERSITY
Fiscal Year: 2024
Award: $719,401
Funding agency: National Institute on Drug Abuse
Project Summary
There have been numerous outbreaks of human immunodeficiency virus (HIV) among people who use drugs (PWUD)
since the well-publicized outbreak in Scott County, Indiana in 2015. In addition to HIV infections, hepatitis C virus
(HCV) infections, skin and soft tissue infections (SSTI), sexually transmitted infections (STIs), and infective endocarditis
(IE) commonly occur among PWUD, along with fatal and non-fatal overdoses (ODs). Furthermore, for the past decade
rates of syphilis have risen dramatically among PWUD, both among injectors and non-injectors, creating additional risk
for HIV transmission through sexual contact. This has created a “converging public health crisis” that threatens the
success of the federal Ending the HIV Epidemic initiative in the United States (US). No single prevention or containment
approach is going to end the HIV epidemic among PWUD. We require an integrated set of strategies that address
outbreaks at different stages of their life cycle. In this proposal, we will develop and evaluate a portfolio of novel methods
that will permit decision makers to predict and detect new outbreaks and get patients diagnosed with greater speed,
accuracy, and efficiency. In short, we aim to intervene at three critical stages in outbreak emergence: 1) Prediction: we
will build on our prior work to develop and evaluate modeling and pattern-recognition frameworks that permit the earliest
and most reliable forecasts possible of jurisdictions at high risk of incipient outbreaks; 2) Detection: we will develop
novel algorithms to minimize the time it takes to detect new outbreaks once they have begun; and finally; 3) Diagnosis:
we will expand upon our previous work to optimize sampling and search algorithms to diagnose previously undiagnosed
cases through community-based active case finding. The proposed studies will provide a novel framework for addressing
outbreaks of infectious diseases, from potential threat, to emerging outbreak, to endemic persistence, offering
methodological innovations alongside the development of practical decision support tools for health departments around
the country in addressing the most serious infectious complications of substance use. These tools will be designed to make
it easier to pinpoint locales at risk of outbreaks among PWUD, more quickly identify them when they do occur, and find
patients in need of care more efficiently as public health officials seek to manage these outbreaks. However, while these
tools will be designed for HIV infection, particularly in the context of drug use, they are pathogen- and population-
agnostic and can be used in the context of active surveillance for other infectious diseases and among other demographic
groups.
Terms: <AIDS Virus><Accounting><Acquired Immune Deficiency Syndrome Virus><Acquired Immunodeficiency Syndrome Virus><Address><Algorithms><Breathing><COVID screening><COVID-19 screening><COVID19 screening><Caring><Collaborations><Communicable Diseases><Communities><Containment><Country><County><Data><Detection><Development><Diagnosis><Disease><Disease Outbreaks><Disorder><Drug usage><Drug user><Drugs><Epidemic><Equity><Fingerprint><Flare><Goals><Groups at risk><HCV><HCV infection><HIV><HIV Infections><HTLV-III Infections><HTLV-III-LAV Infections><Health><Hepatitis C><Hepatitis C virus><Hepatitis C virus infection><Hepatitis, Viral, Non-A, Non-B, Parenterally-Transmitted><Hepatitus C><Hospitals><Human Immunodeficiency Viruses><Human T-Lymphotropic Virus Type III Infections><Indiana><Infection><Infectious Disease Pathway><Infectious Diseases><Infectious Disorder><Infectious Skin Diseases><Infective endocarditis><Intervention><Intervention Strategies><LAV-HTLV-III><Life Cycle><Life Cycle Stages><Locales><Lymphadenopathy-Associated Virus><METH use><Medication><Mental Health><Mental Hygiene><Methodology><Methods><Modeling><Municipalities><NIH><National Institutes of Health><New York City><Outbreaks><Overdose><PWUD><Patients><Pattern><Pattern Recognition><People at risk><Persons at risk><Pharmaceutical Preparations><Pilot Projects><Population><Population Surveillance><Populations at Risk><Prevention><Probabilistic Models><Probability Models><Psychological Health><Public Health><Public Health Surveillance><Reporting><Research><Respiratory Aspiration><Respiratory Inspiration><Risk><SARS-CoV-2 screening><Sampling><Sexually Transmitted Diseases><Sexually Transmitted Disorder><Sexually Transmitted Infection><Soft Tissue Infections><Speed><Statistical Models><Strategic Planning><Syphilis><Technology><Test Result><Testing><Time><Transmission><United States><United States National Institutes of Health><Venereal Diseases><Venereal Disorders><Venereal Infections><Virus-HIV><Work><case finding><coronavirus disease 2019 screening><coronavirus disease screening><coronavirus screening><cutaneous infection><design><designing><developmental><drug use><drug/agent><emergent outbreak><emerging outbreak><great pox><hep C><hepatitis non A non B><high risk><improved><improved outcome><infected skin><infection by hepatitis c virus><innovate><innovation><innovative><inspiration><interventional strategy><life course><methamphetamine use><new outbreak><non A, non B hepatitis><non-A, non-B hepatitis><novel><novel outbreak><opiate crisis><opioid crisis><opioid epidemic><outbreak concern><outbreak forecasting><outbreak potential><outbreak prediction><outbreak risk><outbreak threat><overdose death><overdose fatalities><pathogen><people who use drugs><people who use illicit drugs><persons who use drugs><pilot study><prevent><preventing><severe acute respiratory syndrome coronavirus 2 screening><sexually acquired infection><simulation><skin infection><statistical linear mixed models><statistical linear models><substance use><substance using><success><support tools><tool><transmission process><uptake>