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The Globe and Mail

Indiana town adopts B.C.’s HIV-treatment model after outbreak

Needles that clients can get as part of the needle exchange program at the Austin Community Outreach Center in Austin, Ind. The HIV outbreak began last year and is linked to intravenous injection of opiate pain medication that users crush.

Darron Cummings/AP Photo

A small Indiana community where two out of every five residents are considered at high risk of HIV infection is reaching out to B.C. experts for help.

Austin, Ind., is suffering through an unprecedented outbreak of the disease. With a population of 4,200, 10 per cent are currently injecting prescription opioid drugs on a daily basis, said Diane Janowicz, assistant professor at the Indiana University School of Medicine.

Since last year, 184 new HIV infections have been identified.

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"Thirty-nine per cent of the population are identified as high risk. That's an incredibly high prevalence compared to other parts in the U.S.," Dr. Janowicz said.

The university, working with the National Institute on Drug Abuse, has asked for help from the BC Centre for Excellence in HIV/AIDS. The intention is for the centre to bring its so-called treatment-as-prevention model of health care to the beleaguered community. Treatment-as-prevention is a collection of antiretroviral treatments that reduce the HIV virus load in blood and vaginal and rectal fluids, to decrease the risk of HIV transmission.

B.C. has seen a steady decrease in the number of deaths resulting from HIV since the introduction of an intense antiretroviral therapy program that began in 1996. There has been a 90-per-cent decrease in the number of new cases since 30 years ago.

As of last year, only 250 cases of HIV were recorded in B.C.

In Austin, the outbreak began last year and is linked to intravenous injection of opiate pain medication that users crush. It has prompted a warning from the U.S. Centers for Disease Control and Prevention to alert health officials to be on guard against clusters of HIV and hepatitis C infections.

"Indiana University will bring their colleagues here to see how we implemented our strategies in British Columbia, to learn about our treatment programs and to see how we have made the improvement happen," said Julio Montaner, director of the BC Centre for Excellence of AIDS/HIV.

"It's easier said than done. This program is very complex and it is difficult to implement," he said.

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For example, he said it can be difficult for doctors to reach patients and ensure they have access to the kinds of drugs and programs needed for the therapy to be effective.

A state epidemiologist said in a news report in the Indy Star last year that fewer than half those diagnosed with HIV had been prescribed antiretroviral treatments.

Prior to the outbreak in Austin, there was only one clinic providing health care in the town.

The Indiana team, including the B.C. doctors, plans to use mapping technology to examine risk factors for HIV transmission. Other research will investigate the clustering of HIV transmissions. And scientists will evaluate how to counter the damage of injection-drug use through harm-reduction services.

"The situation in Indiana marks a critical need for implementing best practices in harm reduction and HIV prevention. Treatment-as-prevention is a model for opening up access to early HIV treatment and care, for reducing stigma and for targeted disease elimination," Dr. Montaner said in a news release.

"Providing sustained, consistent treatment and care ensures that an individual's viral load decreases, dramatically reducing the likelihood of disease progression and secondarily stopping HIV transmission."

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B.C.'s treatment model has also been widely adopted in other jurisdictions of the world including China, Latin America and Europe.

"The BC Centre for Excellence in HIV/AIDS is recognized internationally for [its] outstanding work in providing access to treatment and care for those affected by or at high risk of HIV in urban and rural areas in British Columbia," Dr. Janowicz said.

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