Estimating the Impact of Public Health Advisors and State DIS in Resolving Indiana's HIV Outbreak

Background: Public Health Advisors (PHA) have been essential to STD control for decades.  The number of field PHAs has dwindled to a current low of 94 from a high of 511 PHAs in 1992 but remains the largest single classification of employees that CDC offers to aid in public health outbreaks or environmental crises in the US and around the world.  In 2015, Indiana experienced an outbreak of HIV among people who inject drugs in an isolated county.  The state received assistance from 24 DIS from the Division of STD Prevention (DSTDP) PHAs and 18 from state STD programs who volunteered to work in Indiana to stop the outbreak.

Methods:  Field records initiated between January and June 2015 in this county were examined to determine the number of investigations able to be conducted both with and without the PHAs. Positivity of those tested and source of case-finding was also examined.

Results: A total of 128 investigations were conducted between January and March, 2015 using in-state resources resulting in an average of 10 investigations per week, yielding 72 new positive individuals. Between April and June when the PHAs were deployed, a total of 519 investigations occurred (40 per week), yielding 82 new positive individuals. The timely testing, partner services and HIV care provided by DSTDP PHAs in addition to state DIS helped curtail the outbreak in six months, from 154 new positive individuals (January – June 2015) to 10 new positives (July – December 2015). Without the additional DIS, the outbreak may have taken two years to resolve.

Conclusions: In Indiana’s experience, the added PHAs from CDC and DIS from other states were instrumental in resolving the HIV outbreak in a timely manner through provision of partner services.  Public Health Advisors with DSTDP and state DIS are a critical resource in control of outbreaks.