Association between injection of ‘Snow blow’ and HIV infections among homeless people who inject drugs in Dublin, Ireland, 2015

Background February 2015 Unexpected increase in acute HIV infection among PWID – 3 cased in January and February compares to 2 in whole year in 2014 And Increased use of a new psychoactive substance α-PVP (Snow blow) among chaotic PWID Epidemiological and case-control study instigated

Number of recent HIV infections or diagnoses with epidemiological link to PWID in Dublin, by month of first diagnosis, January 2014 to September 2015 (n = 38)

Demographic Characteristics Of the 38 cases: Female: 16 Median age: 35 years (range 24 – 51) Registered homeless: 29 Reported injecting Snow blow: 18 (out of 20 for whom information was available) Sex with PWID or HIV +ve partner: 20

Case control study (Cases 15; Controls 39) Factors positively associated with recent HIV infection Adjusted odds ratio 95% Confidence Interval P value Injecting snow blow493.6 – Reusing needles/ Syringes – Having sex with PWID361.6 – Female sex Factors positively associated with recent HIV infection in multiple regression analysis, case–control study, outbreak of recent HIV infection in PWID, Dublin, Ireland, 2015

Response In response to the increased incidence of HIV the following immediate control measures are being implemented: Provision of antiretroviral therapy to PWID diagnosed with HIV, where possible, and contact tracing to detect any additional cases among sexual or drug sharing partners Review of clients attending drug services, to identify those most at risk, and offering urgent HIV testing Pilot point of care testing (POCT) of PWID clients attending the Safety Net homelessness services Enhanced surveillance to identify new HIV cases as early as possible, including mode of transmission

Response In response to the increased incidence of HIV the following immediate control measures are being implemented: Awareness raising among clients, clinicians, networks of PWID and other stakeholders Provision of greater access to needle exchange and other preventive activities within the drugs, homeless hostel services and prisons. The need for additional measures, including the provision of extended opening hours for needle exchange, is being evaluated Development and distribution of communications material, aimed at raising awareness of the risk of HIV among PWID posed by unsafe injections and unsafe sex. This is available on the HPSC website. Active case finding including Recent Infection Testing of possible cases Phylogenetic analysis of cases

References Giese, C., D. Igoe, Z. Gibbons, C. Hurley, S. Stokes, S. McNamara, O. Ennis, K. O'Donnell, E. Keenan, C. De Gascun, F. Lyons, M. Ward, K. Danis, R. Glynn, A. Waters, and M. Fitzgerald (2015) “Injection of new psychoactive substance snow blow associated with recently acquired HIV infections among homeless people who inject drugs in Dublin, Ireland, 2015.” Euro surveillance : bulletin Européen sur les maladies transmissibles = European communicable disease bulletin 20(40): Euro Surveill. Glynn, R., C. Giese, O. Ennis, Z. Gibbons, K. O’Donnell, C. Hurley, M. Ward, D. Igoe, M. Fitzgerald (2015) Increase in diagnoses of recently acquired HIV in people who inject drugs, Epi Insight: Disease Surveillance Report of Health Protection and Surveillance Centre, Ireland, Volume 16, Issue 7, July 2015