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Principal Investigator: Peter F Rebeiro
Organization: VANDERBILT UNIVERSITY MEDICAL CENTER
Fiscal Year: 2024
Award: $371,875
Funding agency: National Institute on Drug Abuse
Project Summary / 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.
Terms: <AIDS><AIDS Virus><AIDS/HIV><Acquired Immune Deficiency><Acquired Immune Deficiency Syndrome><Acquired Immune Deficiency Syndrome Virus><Acquired Immunodeficiency Syndrome><Acquired Immunodeficiency Syndrome Virus><Acute Hepatitis><Acute Hepatitis C><Address><Affect><Alabama><Antibodies><Antigens><Application Context><Area><Behavior><Behavioral><Big Data><BigData><COVID crisis><COVID epidemic><COVID pandemic><COVID-19><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><CV-19><Centers for Disease Control><Centers for Disease Control and Prevention><Centers for Disease Control and Prevention (U.S.)><Cessation of life><Characteristics><Chronic Hepatitis C><Chronic type C viral hepatitis><Chronic viral hepatitis C><Classification><Collaborations><Coronavirus Infectious Disease 2019><County><Data><Death><Disease><Disease Outbreaks><Disorder><Drugs><Epidemic><Epidemiologic Research><Epidemiologic Studies><Epidemiological Studies><Epidemiologist><Epidemiology><Epidemiology Research><Event><Funding><Future><Groups at risk><HCV><HCV Incidence><HCV Transmission><HCV co-infection><HCV coinfection><HCV infection><HCV/HIV><HIV><HIV and HCV><HIV and hepatitis C><HIV diagnosis><HIV risk><HIV-HCV><HIV/AIDS><HIV/HCV><HIV/Hepatitis C><Health><Hepatitis C><Hepatitis C Incidence><Hepatitis C Transmission><Hepatitis C co-infection><Hepatitis C virus><Hepatitis C virus infection><Hepatitis, Viral, Non-A, Non-B, Parenterally-Transmitted><Hepatitus C><Human Immunodeficiency Viruses><Impoverished><Incidence><Indiana><Individual><Intervention><Intervention Strategies><Investigators><Kentucky><LAV-HTLV-III><Laboratories><Laws><Legal><Link><Literature><Lymphadenopathy-Associated Virus><Math Models><Medication><Methods><Mind><Modeling><Monitor><NIH><Naloxone><Narcan><Narcanti><National Institutes of Health><Needle-Exchange Programs><Neighborhoods><Nucleic Acid Amplification Tests><Nucleic Acid Testing><Opiate Addiction><Opiate Dependence><Opiates><Opioid><Outbreaks><Outcome><Overdose><Pattern><People at risk><Persons><Persons at risk><Pharmaceutical Preparations><Policies><Population><Populations at Risk><Poverty><Predisposition><Pregnant Women><Prescription drug overdose><Prescription overdose><Prevention><Prevention Research><Probability><Proxy><Public Health><Reporting><Research><Research Personnel><Research Resources><Researchers><Resources><Risk><Risk Behaviors><Risky Behavior><Role><Rural><Rural Community><Rural Population><Rural group><Rural people><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Scourge><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Source><South Carolina><Surveillance Program><Susceptibility><Syringe-Exchange Programs><System><Systematics><Tennessee><Territorialities><Territoriality><Time><Translating><Transmission><Transportation><United States Centers for Disease Control><United States Centers for Disease Control and Prevention><United States National Institutes of Health><Update><Urban Community><Viral><Virginia><Virus-HIV><West Virginia><Work><assault><at risk behavior><causal diagram><causal model><chronic HCV infection><chronic hepatitis C virus infection><co-infection><co-morbid><co-morbidity><coinfection><comorbidity><computer based prediction><contextual factors><coronavirus disease 2019><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><coronavirus infectious disease-19><dashboard><data dissemination><data driven platform><data heterogeneity><data platform><data set heterogeneity><dataset heterogeneity><disparate effect><disparate impact><disparate result><drug/agent><epidemiologic><epidemiologic investigation><epidemiological><epidemiological model><epidemiology study><expectant mother><expecting mother><fetal><hep C><hepatitis C coinfection><hepatitis C virus co-infection><hepatitis C virus coinfection><hepatitis C virus incidence><hepatitis C virus transmission><hepatitis non A non B><heterogeneous data><heterogeneous data sets><heterogeneous datasets><heterogenous data><heterogenous data sets><heterogenous datasets><high reward><high risk><immunogen><improved><indexing><inequitable effect><inequitable impact><inequitable outcome><infection by hepatitis c virus><informatics infrastructure><injection drug use><interest><interventional strategy><intravenous opiate><intravenous opioid><licit opioid><mathematic model><mathematical model><mathematical modeling><mortality><needle exchange><non A, non B hepatitis><non-A, non-B hepatitis><novel><opiate abuse><opiate consumption><opiate crisis><opiate drug abuse><opiate drug use><opiate injection><opiate intake><opiate medication><opiate overdose><opiate related overdose><opiate use><opioid abuse><opioid addiction><opioid consumption><opioid crisis><opioid dependence><opioid dependent><opioid drug abuse><opioid drug overdose><opioid drug use><opioid epidemic><opioid guideline><opioid induced overdose><opioid injection><opioid injector><opioid intake><opioid intoxication><opioid law><opioid legislation><opioid medication><opioid medication overdose><opioid overdose><opioid poisoning><opioid policy><opioid related overdose><opioid toxicity><opioid use><outcome disparities><outcome inequality><outcome inequity><overdose death><overdose fatalities><overdose prevention><pandemic disease preparedness><pandemic planning><pandemic preparedness><pandemic readiness><predictive modeling><pregnant mothers><prescribed opiate><prescribed opioid><prescription opiate><prescription opioid><prevent><preventing><programs><public health intervention><public health relevance><rural area><rural dwelling><rural households><rural individual><rural locality><rural location><rural place><rural region><rural residence><rural setting><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><shareable platform><sharing platform><social health determinants><social role><socio-demographics><sociodemographics><substance use><substance using><syndemic><synergistic epidemic><syringe exchange><syringe exchange services><syringe service programs><transmission process><unequal effect><unequal impact><unequal outcome><urban area><urban environment><urban location><urban region><urban setting><viral testing><virus testing>