Tennessee's In-state Vulnerability Assessment for a "Rapid Dissemination of Human Immunodeficiency Virus or Hepatitis C Virus Infection" Event Utilizing Data About the Opioid Epidemic
Tennessee's In-state Vulnerability Assessment for a "Rapid Dissemination of Human Immunodeficiency Virus or Hepatitis C Virus Infection" Event Utilizing Data About the Opioid Epidemic
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DOI：
10.1093/cid/cix1079
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发表时间：
2018-06-01
影响因子：
11.8
通讯作者：
McPheeters, Melissa
中科院分区：
文献类型：
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作者：
Rickles, Michael;Rebeiro, Peter F.;McPheeters, Melissa
背景。了解哪些因素导致县级容易受到人类免疫缺陷病毒 (HIV)/丙型肝炎病毒 (HCV) 爆发的影响，以及哪些县最容易受到影响，从而指导公共卫生和临床干预措施。因此，我们研究了与阿片类药物流行相关的当地可用指标对先前国家艾滋病毒/丙型肝炎爆发脆弱性模型的影响。方法。田纳西州的 95 个县是研究样本。使用 2012 年和 2013 年的预测变量，反映了美国疾病控制与预防中心 (CDC) 先前的方法。丙肝病毒急性发病率是县级脆弱性的替代指标。 78 个预测因素被确定为 HIV/HCV 易感性的潜在预测因素。我们使用多维降维技术来确定纳入的预测因子，并使用泊松回归来生成对县级 HIV/HCV 脆弱性进行排名的综合指数得分。结果。高风险县与国家分析存在重叠（41 个县中的 25 个县）。脆弱性的分布强化了早期研究表明田纳西州东部的风险特别高，但也表明整个州都具有很高的脆弱性。结论。先前的研究将田纳西州列为阿片类药物处方、急性丙型肝炎病毒感染和艾滋病毒/丙型肝炎病毒爆发风险最高的州之一。鉴于这种风险的汇合，田纳西州卫生部在之前的工作基础上进行了扩展，纳入了更精细的本地数据，包括阿片类药物处方数据。我们还探讨了非致命和致命的药物过量。不仅在东部县，而且在西部走廊，对全州范围内产生的风险进行更全面的了解，将使地方官员能够监控脆弱性并更好地瞄准资源。
Background. Knowing which factors contribute to county-level vulnerability to a human immunodeficiency virus (HIV)/hepatitis C virus (HCV) outbreak, and which counties are most vulnerable, guides public health and clinical interventions. We therefore examined the impact of locally available indicators related to the opioid epidemic on prior national models of HIV/HCV outbreak vulnerability.Methods. Tennessee's 95 counties were the study sample. Predictors from 2012 and 2013 were used, mirroring prior methodology from the US Centers for Disease Control and Prevention (CDC). Acute HCV incidence was the proxy measure of county-level vulnerability. Seventy-eight predictors were identified as potentially predictive for HIV/HCV vulnerability. We used multiple dimension reduction techniques to determine predictors for inclusion and Poisson regression to generate a composite index score ranking county-level vulnerability for HIV/HCV.Results. There was overlap of high-risk counties with the national analysis (25 of 41 counties). The distribution of vulnerability reinforces earlier research indicating that eastern Tennessee is at particularly high risk but also demonstrates that the entire state has high vulnerability.Conclusions. Prior research placed Tennessee among the top states for opioid prescribing, acute HCV infection, and greatest risk for an HIV/HCV outbreak. Given this confluence of risk, the Tennessee Department of Health expanded upon prior work to include more granular, local data, including on opioid prescribing. We also explored nonfatal and fatal overdoses. The more complete statewide view of risk generated, not only in eastern counties but also in the western corridor, will enable local officials to monitor vulnerability and better target resources.