{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T12:15:55Z","timestamp":1770984955955,"version":"3.50.1"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"Supplement_5","license":[{"start":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T00:00:00Z","timestamp":1599004800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,9,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In 2018, Philadelphia identified an outbreak of new human immunodeficiency virus (HIV) infections among persons who inject drugs (PWID). Although conventional HIV surveillance systems capture individual-level behavioral risk, they are not able to capture the social and environmental factors contributing to rapid transmission.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>HIV surveillance data were used to assess demographic, clinical, and behavioral factors for PWID with HIV diagnosed during 2017 and 2018. Social factors such as homelessness, disruption of encampments, and trends in sexual behaviors, drug use and syringe availability among PWID were captured through National HIV Behavioral Surveillance, routine hepatitis and sexually transmitted infection surveillance, and shelter and homeless outreach data.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In 2018, there were 71 new infections among PWID, an increase of 115% since 2016. During this time, opioid overdose deaths peaked at 59 deaths per 100 000 persons, 85% of which involved the use of fentanyl. While overall reported homelessness increased, rates of those living unsheltered rose by 13%. The Philadelphia Department of Public Health identified increased injection frequency, encampment closures, and lack of syringe access as promoters of continued HIV transmission.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The use of conventional surveillance methods only is inadequate for determining HIV risk during outbreaks. Incorporation of individual and aggregate level data on social and environmental determinants is necessary to develop effective outbreak response interventions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/infdis\/jiaa128","type":"journal-article","created":{"date-parts":[[2020,3,20]],"date-time":"2020-03-20T20:09:49Z","timestamp":1584734989000},"page":"S250-S258","source":"Crossref","is-referenced-by-count":21,"title":["Understanding the Intersection of Behavioral Risk and Social Determinants of Health and the Impact on an Outbreak of Human Immunodeficiency Virus Among Persons Who Inject Drugs in Philadelphia"],"prefix":"10.1093","volume":"222","author":[{"given":"Melissa M","family":"Kim","sequence":"first","affiliation":[{"name":"Philadelphia Department of Public Health, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S Caitlin","family":"Conyngham","sequence":"additional","affiliation":[{"name":"Philadelphia Department of Public Health, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Champagnae","family":"Smith","sequence":"additional","affiliation":[{"name":"Philadelphia Department of Public Health, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dana","family":"Higgins","sequence":"additional","affiliation":[{"name":"Philadelphia Department of Public Health, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanner","family":"Nassau","sequence":"additional","affiliation":[{"name":"Philadelphia Department of Public Health, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Coleman","family":"Terrell","sequence":"additional","affiliation":[{"name":"Philadelphia Department of Public Health, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen A","family":"Brady","sequence":"additional","affiliation":[{"name":"Philadelphia Department of Public Health, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,9,2]]},"reference":[{"key":"2020090213231700800_CIT0001","volume-title":"Surveillance report","year":"2018"},{"key":"2020090213231700800_CIT0002","doi-asserted-by":"crossref","first-page":"2922","DOI":"10.1007\/s10461-016-1393-y","article-title":"Trend analyses of users of a syringe exchange program in Philadelphia, Pennsylvania: 1999\u20132014","volume":"20","author":"Maurer","year":"2016","journal-title":"AIDS Behav"},{"key":"2020090213231700800_CIT0003","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1057\/jphp.2014.54","article-title":"State laws, syringe exchange, and HIV among persons who inject drugs in the United States: history and effectiveness","volume":"36","author":"Bramson","year":"2015","journal-title":"J Public Health Policy"},{"key":"2020090213231700800_CIT0004","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1093\/ije\/dyt243","article-title":"Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: a systematic review and meta-analysis","volume":"43","author":"Aspinall","year":"2014","journal-title":"Int J Epidemiol"},{"key":"2020090213231700800_CIT0005","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1097\/00002030-200107270-00002","article-title":"Effectiveness of syringe exchange programs in reducing HIV risk behavior and HIV seroconversion among injecting drug users","volume":"15","author":"Gibson","year":"2001","journal-title":"AIDS"},{"key":"2020090213231700800_CIT0006","doi-asserted-by":"crossref","first-page":"S148","DOI":"10.1097\/QAI.0000000000002176","article-title":"Using interrupted time series analysis to measure the impact of legalized syringe exchange on HIV diagnoses in Baltimore and Philadelphia","volume":"82(suppl 2)","author":"Ruiz","year":"2019","journal-title":"J Acquir Immune Defic Syndr"},{"key":"2020090213231700800_CIT0007","author":"Prevention Point Philadelphia"},{"key":"2020090213231700800_CIT0008","doi-asserted-by":"crossref","first-page":"S48","DOI":"10.1097\/01.qai.0000248338.74943.85","article-title":"Impact of enhanced services on virologic outcomes in a directly administered antiretroviral therapy trial for HIV-infected drug users","volume":"43","author":"Smith-Rohrberg","year":"2006","journal-title":"J Acquir Immune Defic Syndr"},{"key":"2020090213231700800_CIT0009","doi-asserted-by":"crossref","first-page":"1858","DOI":"10.1097\/QAD.0000000000001117","article-title":"HIV infection among persons who inject drugs: ending old epidemics and addressing new outbreaks: authors\u2019 reply","volume":"30","author":"Des Jarlais","year":"2016","journal-title":"AIDS"},{"key":"2020090213231700800_CIT0010","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1007\/s10461-017-1731-8","article-title":"Preventing HIV and hepatitis infections among people who inject drugs: leveraging an Indiana outbreak response to break the impasse","volume":"21","author":"Crowley","year":"2017","journal-title":"AIDS Behav"},{"key":"2020090213231700800_CIT0011","doi-asserted-by":"crossref","first-page":"253","DOI":"10.15585\/mmwr.mm6810a6","article-title":"HIV diagnoses among persons who inject drugs\u2014Northeastern Massachusetts, 2015\u20132018","volume":"68","author":"Cranston","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2020090213231700800_CIT0012","doi-asserted-by":"crossref","first-page":"465","DOI":"10.2105\/AJPH.91.3.465a","article-title":"A definition of \u201csocial environment.\u201d","volume":"91","author":"Barnett","year":"2001","journal-title":"Am J Public Health"},{"key":"2020090213231700800_CIT0013","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1097\/COH.0b013e32830136a0","article-title":"Understanding and integrating the structural and biomedical determinants of HIV infection: a way forward for prevention","volume":"3","author":"Kippax","year":"2008","journal-title":"Curr Opin HIV AIDS"},{"key":"2020090213231700800_CIT0014","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1186\/1471-2458-13-482","article-title":"Modified social ecological model: a tool to guide the assessment of the risks and risk contexts of HIV epidemics","volume":"13","author":"Baral","year":"2013","journal-title":"BMC Public Health"},{"key":"2020090213231700800_CIT0015","doi-asserted-by":"crossref","first-page":"S102","DOI":"10.1086\/651480","article-title":"Developing and evaluating comprehensive HIV infection control strategies: issues and challenges","volume":"50","author":"DeGruttola","year":"2010","journal-title":"Clin Infect Dis"},{"key":"2020090213231700800_CIT0016","first-page":"S135","article-title":"Social determinants and the health of drug users: socioeconomic status, homelessness, and incarceration","volume":"117","author":"Galea","year":"2002","journal-title":"Public Health Rep"},{"key":"2020090213231700800_CIT0017","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/s10461-005-9000-7","volume":"9","author":"Aidala","year":"2005","journal-title":"AIDS Behav"},{"key":"2020090213231700800_CIT0018","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.drugpo.2017.06.010","article-title":"Fentanyl in the US heroin supply: a rapidly changing risk environment","volume":"46","author":"Ciccarone","year":"2017","journal-title":"Int J Drug Policy"},{"key":"2020090213231700800_CIT0019","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1097\/QAI.0000000000001098","article-title":"County-level vulnerability assessment for rapid dissemination of HIV or HCV infections among persons who inject drugs, United States","volume":"73","author":"Van Handel","year":"2016","journal-title":"J Acquir Immune Defic Syndr"},{"key":"2020090213231700800_CIT0020","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1177\/00333549071220S108","article-title":"Developing an HIV behavioral surveillance system for injecting drug users: the National HIV Behavioral Surveillance System","volume":"122","author":"Lansky","year":"2007","journal-title":"Public Health Rep"},{"key":"2020090213231700800_CIT0021","doi-asserted-by":"crossref","first-page":"1943","DOI":"10.1056\/NEJMra1011874","article-title":"Acute HIV-1 infection","volume":"364","author":"Cohen","year":"2011","journal-title":"N Engl J Med"},{"key":"2020090213231700800_CIT0022","volume-title":"The opioid threat in Pennsylvania","year":"2018"},{"key":"2020090213231700800_CIT0023","author":"Health of the city 2018","year":"2019"},{"key":"2020090213231700800_CIT0024","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1093\/jurban\/jth145","article-title":"Homelessness and HIV risk behaviors among injection drug users","volume":"81","author":"Metraux","year":"2004","journal-title":"J Urban Health"},{"key":"2020090213231700800_CIT0025","first-page":"9","article-title":"\u201cBig events\u201d and networks","volume":"27","author":"Friedman","year":"2006","journal-title":"Connect (Tor)"},{"key":"2020090213231700800_CIT0026","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1111\/j.1360-0443.2006.01431.x","article-title":"The dynamics of injection drug users\u2019 personal networks and HIV risk behaviors","volume":"101","author":"Costenbader","year":"2006","journal-title":"Addiction"},{"key":"2020090213231700800_CIT0027","volume-title":"HIV outbreak among people who inject drugs (PWID): health advisory.","year":"2019"}],"container-title":["The Journal of Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jid\/article-pdf\/222\/Supplement_5\/S250\/33708091\/jiaa128.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jid\/article-pdf\/222\/Supplement_5\/S250\/33708091\/jiaa128.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T19:12:58Z","timestamp":1599073978000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jid\/article\/222\/Supplement_5\/S250\/5900599"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,2]]},"references-count":27,"journal-issue":{"issue":"Supplement_5","published-online":{"date-parts":[[2020,9,2]]},"published-print":{"date-parts":[[2020,9,2]]}},"URL":"https:\/\/doi.org\/10.1093\/infdis\/jiaa128","relation":{},"ISSN":["0022-1899","1537-6613"],"issn-type":[{"value":"0022-1899","type":"print"},{"value":"1537-6613","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,10,1]]},"published":{"date-parts":[[2020,9,2]]}}}