Poisoning Data for HIV/HCV Prevention Injury and Violence Prevention Unit
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1 Channeling John Snow: Poisoning Data for HIV/HCV Prevention Injury and Violence Prevention Unit
2 HIV Outbreak in Southeastern Indiana
3 Community Outbreak of HIV in Rural Indiana Early 2015, investigation began into new HIV infections in rural Indiana County. By end of January 2015, 11 confirmed cases were identified. Historically, this county of Indiana had less than five cases annually. Outbreak associated with syringe-sharing partners injection prescription opioids.
4 Concern at the Minnesota Department of Health Concerns about the ability to detect and respond to similar outbreak in Minnesota. Workgroup convened at MDH that included members from injury prevention and infectious disease. Goals of workgroup: Identify potentially high risk areas for outbreak from current data sources. Locations where future resources for prevention should be placed in Minnesota.
5 Currently Available Data Injury data sources: Minnesota hospital discharge data Minnesota death certificates HIV/HCV data sources: HIV and HCV surveillance for the state of Minnesota
6 Injury Data Sources Minnesota hospital discharge data: 2009 to 2014 ICD-9-CM codes for poisoning, abuse, or dependency for opiate/opioid, cocaine, meth/amphetamine. Cases totaled per year by patient s county of residence, and top ten counties mapped. Total number of cases per year for patient s ZIP Code of residence also mapped. Seven county metro area excluded in secondary analysis. Minnesota death certificates: 2009 to 2014 ICD-10-CM codes for mental and behavioral disorder due to substance use, and poisoning by drugs for opioids, cocaine, meth/amphetamine. Same methods used for mapping as in HDD.
7 HIV and HCV Surveillance Data Results from analysis with HDD and death certificates compared with: Census tract data on cases of HIV that had injection drug use as risk factor from 2009 to Acute cases of HCV under the age of 30 identified from 2009 to 2014.
8 Drug Hospitalizations and Deaths Including Metro County Hospitalizations Hennepin Ramsey Saint Louis Anoka Dakota Washington Olmsted Carlton Sherburne Wright Total 2335 Rate (per 100,000) County Deaths Rate (per 100,000) Hennepin Ramsey Anoka Dakota Saint Louis Washington Olmsted Wright Sherburne Scott Total 1936
9 Drug Hospitalizations and Deaths Hospitalizations County Maps Deaths
10 Drug Hospitalizations and Deaths ZIP Code Maps Hospitalizations Deaths
11 Drug Hospitalizations and Deaths Excluding Metro County Hospitaliz -ations Saint Louis Olmsted Carlton Sherburne Wright Stearns Goodhue Beltrami Cass Crow Wing Total 697 Rate (per 100,000) County Deaths Rate (per 100,000) Saint Louis Olmsted Wright Stearns Sherburne Carlton Chisago Winona Crow Wing Mille Lacs Total 412
12 Drug Hospitalizations and Deaths County Maps Hospitalizations Deaths
13 Drug Hospitalizations and Deaths ZIP Code Maps Hospitalizations Deaths
14 HCV Infection Map Overlays Including Metro Excluding Metro
15 Result Highlights Counties and ZIP Codes in metro area account for majority of hospitalizations and deaths. When excluding metro, counties in Rochester, Saint Cloud, and Duluth have greatest number of cases. ZIP Code information more difficult to interpret. The analysis of HCV and HIV cases identified similar areas of Minnesota.
16 Where May this Analysis Lead to? Results of analysis validate current knowledge and highlight new areas of state with increased drug use and incidence of HIV/HCV. Overlay current locations of needle exchange programs. May help direct future prevention and harm reduction resources with increased funds.
17 Replication of Analysis with CDC Methods County Level Vulnerability to Rapid Dissemination of HIV/HCV Infection among Persons who Inject Drugs Compare with results from this analysis.
18 Acknowledgments Injury and Violence Prevention Unit Jon Roesler Mark Kinde Dana Farley Infectious Disease, Epidemiology, Prevention, and Control Kristin Sweet Kris Ehresmann Genny Grilli Kathy Chinn Allison LaPointe Krissie Guerard Director of American Indian Health Jackie Dionne State Epidemiologist and Medical Director Ruth Lynfield
19 Thank you! Questions? NATE WRIGHT SAMHSA/CSTE Epidemiology Fellow Minnesota Department of Health Injury and Violence Prevention Unit
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