Infectious Disease Challenges Among Individuals with Substance Use Disorders

Overview

Over the past two decades, infectious diseases including HIV, viral hepatitis, bacterial infections, and STIs have surged among people with substance use disorders (SUDs). Integrated, patient-centered care models and multilevel interventions addressing social determinants are critical to managing these overlapping epidemics.

Background

Individuals with substance use disorders face a syndemic of infectious diseases characterized by interconnected epidemics of bloodborne viruses, invasive infections, and sexually transmitted infections. Social determinants of health and structural factors exacerbate these challenges. Despite advances such as preexposure prophylaxis (PrEP) for HIV and low-threshold hepatitis C treatment, barriers remain in access and uptake. This special collection highlights epidemiology, prevention, and treatment strategies tailored for people who use drugs (PWUD).

Data Highlights

Key Findings

• HIV and viral hepatitis prevalence remain high among PWUD, with disparities linked to race, housing status, and insurance coverage.
• Daily oral PrEP adherence barriers among people who inject drugs (PWID) may be mitigated by long-acting injectable PrEP formulations.
• STI prevalence among PWID is significant, yet routine STI screening is infrequent, underscoring the need for annual testing.
• Integrated infectious disease screening and treatment programs in substance use disorder treatment settings improve care delivery.
• Multilevel barriers, including funding, insurance complexity, and social needs, hinder low-threshold hepatitis C treatment uptake.
• Natural language processing tools can identify PWID in healthcare systems but infectious disease screening remains suboptimal.

Clinical Implications

Clinicians should prioritize integrated infectious disease screening and treatment within substance use disorder care settings to address the syndemic effectively. Expanding access to long-acting PrEP and implementing routine STI screening can reduce new infections. Addressing social determinants and structural barriers is essential to improve treatment uptake and health equity among PWUD.

Conclusion

The syndemic of infectious diseases among individuals with substance use disorders demands comprehensive, integrated approaches that combine clinical care with interventions addressing social and structural factors. Continued innovation and investment in patient-centered models are vital to curb these overlapping epidemics.

References

1. Fujita et al. -- Epidemiology of Syndemic Infections in PWUD
2. Metsch et al. -- Project RETAIN on Viral Suppression in HIV and Cocaine Use
3. McMahan et al. -- Barriers to Daily Oral PrEP and Interest in Long-Acting PrEP
4. Elnaiem et al. -- HCV Treatment Access Disparities in the US
5. Nacht et al. -- STI Prevalence Among PWID in San Diego–Tijuana
6. Ho et al. -- Natural Language Processing to Identify PWID in VHA