When people started to show up to Dr. William Cooke's primary care office in Austin, Ind., in 2014 with HIV, Cooke knew it was probably related to the region's opioid epidemic. But what he and the rest of the public health community didn't know was who they were missing or how long the HIV outbreak had been going on.
Now they've got a clearer picture — literally. In visualizations published in the Journal of Infectious Diseases, dots and lines define the constellations of Indiana's HIV outbreak. Using genetic sequencing, they show how long the outbreak had been going on, connected people who hadn't previously been linked by traditional methods, and showed how the virus jumped from a slowly spreading infection to a virus transmitted quickly via needle sharing and other, smaller sub-epidemics.
Genetic data has been used to track HIV before. But now, the technology is being used to map HIV outbreaks in real time, lending molecular weight to the in-person interviews that public health officials have used for centuries to track and stop outbreaks. The Austin reconstruction is an example of what it can do.
"This is an instrumental tool for bringing new infections down to zero," says John Brooks, senior medical advisor at the Centers for Disease Control and Prevention's Division of HIV/AIDS Prevention. "We have the tools, in terms of treatment reducing transmission to nearly zero. We have prevention... and now we know how to find people."