Clinical Scorecard: Integrated Healthcare Approaches for Individuals Who Use Drugs: Merging Infectious Disease Management, Harm Reduction Strategies, and Primary Care Services
At a Glance
Category
Detail
Condition
Health complications and infectious diseases among people who use drugs (PWUD), including substance use disorder (SUD), HIV, hepatitis C, and injection-related infections
Key Mechanisms
Colocation of primary care, infectious diseases consultation, and harm reduction services within community-based programs trusted by PWUD
Target Population
People who use drugs (PWUD), especially those with substance use disorder and injection drug use
Care Setting
Community-based harm reduction programs and syringe service programs (SSPs) with embedded clinical services
Key Highlights
PWUD face increased risk of infectious diseases and low uptake of primary care due to stigma and logistical barriers.
Community-based harm reduction programs serve as trusted access points for integrated primary care and infectious disease services.
Colocated services in Chicago’s COIP program resulted in high utilization of care addressing SUD, HIV, hepatitis C, and other infections.
Guideline-Based Recommendations
Diagnosis
Screen PWUD for infectious diseases including HIV, hepatitis C, and sexually transmitted infections within harm reduction settings.
Assess for substance use disorder and injection-related complications during clinical encounters.
Management
Provide integrated primary care and infectious disease treatment alongside harm reduction and substance use disorder services.
Utilize trusted community outreach workers with lived experience to facilitate referrals and engagement.
Address chronic medical and psychiatric comorbidities common in PWUD.
Monitoring & Follow-up
Track clinical encounters and service utilization to assess engagement and health outcomes among PWUD.
Monitor infectious disease treatment adherence and response within colocated care models.
Risks
Recognize barriers such as stigma, homelessness, fear of child custody loss, and comorbid health issues that impede care access.
Be aware of high overdose mortality risk, especially opioid-related deaths, in the target population.
Patient & Prescribing Data
552 unique patients who use drugs, predominantly male, median age 43, mostly publicly insured
Majority of clinical encounters (71.3%) addressed active substance use disorder; 20% of encounters involved hepatitis C and HIV care, demonstrating feasibility of integrated service delivery in harm reduction settings.
Clinical Best Practices
Embed primary care and infectious disease providers within harm reduction programs to reduce barriers and stigma.
Employ outreach workers with lived substance use experience to build trust and improve service uptake.
Offer comprehensive care addressing infectious diseases, substance use disorder, and chronic medical conditions in a single accessible location.
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