Brief Longitudinal Incident Sentinel Surveillance (BLISS) to End the HIV Epidemic among Persons Who Inject Drugs (PWID)

The endgame for eliminating HIV will become increasingly difficult as transmission persists among people who inject drugs (PWID). Although San Francisco appears on track to achieve zero new HIV infections within the next few years, the trajectory among PWID lags behind. The slower rate of decrease in HIV among PWID may be due to lower levels of awareness and uptake of pre-exposure prophylaxis (PrEP). Meanwhile, neighboring Alameda County (home to Oakland) has seen little decrease in the HIV epidemic with outbreaks occurring among PWID. In addition to HIV, PWID in the United States are experiencing high levels of deaths due drug overdose. To improve response efforts, data collection systems need to be more rapid and responsive. We therefore propose to create a new epidemiological data collection system for PWID in Alameda and San Francisco counties called Brief Longitudinal Incident Sentinel Surveillance (BLISS). We will recruit 600 PWID (300 each in county) using a novel venue-based / peer-referral hybrid method called Starfish Sampling to accrue a cohort and follow them longitudinally. After HIV testing and an initial questionnaire, participants will be asked to provide brief monthly updates on several key events related to health and substance use, such as changes in preventive practices or overdose experiences. Monthly data will be collected through smart phone and online technologies with in-person options as back up. Selected sentinel events will trigger “deeper dive” data collection through ecological momentary assessments (EMAs). The sample size is designed to detect low-frequency events as early warning signals and to gather sufficient longitudinal data to understand factors influencing health behaviors. BLISS data will help identify and avert outbreaks, micro-target interventions, and address unmet care and prevention needs.