Infectious Diseases in People Who Use Drugs Introduction
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By
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Laura Marks
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October 7, 2025
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0 min
Clinical Scorecard: Infectious Disease Challenges Among Individuals with Substance Use Disorders: An Overview
At a Glance
| Category | Detail |
|---|---|
| Condition | Infectious diseases including HIV, viral hepatitis, bacterial and fungal infections, and sexually transmitted infections among people who use drugs (PWUD) |
| Key Mechanisms | Bloodborne virus transmission, invasive infections, overlapping epidemics characterized by syndemic framework, social determinants and structural factors |
| Target Population | People who use drugs (PWUD), including people who inject drugs (PWID), individuals with substance use disorders (SUDs) |
| Care Setting | Integrated patient-centered services across inpatient, outpatient, syringe service programs, mobile medical units, and Veterans Health Administration facilities |
Key Highlights
- Syndemic framework highlights interconnected epidemics of HIV, viral hepatitis, STIs, and invasive infections among PWUD influenced by social and structural determinants.
- Oral preexposure prophylaxis (PrEP) is effective but faces adherence barriers; long-acting injectable PrEP formulations offer promising alternatives for PWID.
- Low-threshold HCV treatment in nontraditional settings and integrated infectious disease screening in SUD treatment programs improve access and care delivery.
Guideline-Based Recommendations
Diagnosis
- Routine annual screening for bacterial sexually transmitted infections among PWID.
- Comprehensive infectious diseases screening including HIV, viral hepatitis, STIs, and latent tuberculosis infection in PWUD.
- Use of natural language processing tools to identify PWID for targeted screening in healthcare systems.
Management
- Implementation of integrated, multidisciplinary care models addressing infectious diseases and substance use disorders.
- Provision of oral and long-acting injectable PrEP to prevent HIV acquisition in PWUD, with attention to modality preferences and barriers.
- Low-threshold HCV treatment delivery in inpatient, syringe service programs, and mobile medical units to improve treatment access.
Monitoring & Follow-up
- Monitoring viral suppression among people with HIV who use drugs to evaluate effectiveness of integrated care interventions.
- Tracking PrEP awareness, uptake, and adherence patterns among PWID to inform prevention strategies.
- Ongoing assessment of social determinants and structural barriers impacting infectious disease treatment and prevention.
Risks
- Multilevel barriers including social determinants, insurance coverage disparities, and complex healthcare navigation impede infectious disease care.
- Low awareness and uptake of HIV PrEP among PWID increase risk of new HIV infections.
- Insufficient funding and unmet social needs limit implementation and uptake of low-threshold infectious disease treatments.
Patient & Prescribing Data
People who inject drugs (PWID) at risk for HIV and other infectious diseases
Despite effectiveness of oral PrEP, adherence barriers exist; long-acting injectable PrEP shows promise to mitigate these barriers and increase uptake. Integrated care models are needed to address complex individual and environmental factors.
Clinical Best Practices
- Adopt syndemic-informed approaches addressing overlapping infectious diseases and social determinants in PWUD.
- Integrate infectious disease screening and treatment services within substance use disorder treatment settings.
- Utilize innovative tools such as natural language processing to identify high-risk individuals for targeted interventions.
- Expand access to and education about long-acting injectable PrEP among PWID to improve HIV prevention.
- Implement low-threshold, multidisciplinary care models to overcome barriers related to insurance, funding, and social needs.
References
- Ending the HIV Epidemic by 2030
- Oral Preexposure Prophylaxis (PrEP) for HIV Prevention
- Long-Acting Injectable PrEP Approvals
This content is an AI-generated, fully rewritten summary based on a published scholarly article. It does not reproduce the original text and is not a substitute for the original publication. Readers are encouraged to consult the source for full context, data, and methodology.
