Infectious Disease Prevention Services for Substance Use Disorders
People who inject or use drugs are at higher risk for infectious diseases like HIV and hepatitis A, B, and C, often due to needle sharing and limited access to sterile injection equipment. Barriers to testing and treatment in rural areas, including stigma and limited access to services, can further increase risk.
Comprehensive infectious disease prevention services are an essential component of effective substance use disorder programs. This model focuses on preventing disease transmission, supporting early diagnosis and treatment, and using prevention services as entry points to broader healthcare treatment.
Key components of this model for infectious disease prevention services include:
- Vaccination services, particularly for hepatitis A and hepatitis B, which are critical preventive strategies for people who use drugs
- Routine screening and testing for HIV and hepatitis to support early diagnosis and timely treatment
- Care coordination and case management to link individuals to primary care, infectious disease treatment, and other services
- Education and counseling on infection prevention and recognizing symptoms of infectious disease
- Referral to substance use disorder treatment as part of an integrated approach to reducing health risks
In rural areas, these services can help reduce infectious disease transmission while providing low-barrier access points to healthcare and recovery supports.
Examples of Rural Infectious Disease Prevention Programs
- Indiana's ZIP-IN Respond Initiative focuses on rapid identification and response to potential HIV and hepatitis C outbreaks in communities affected by injection drug use. When an outbreak is detected, coordinated response efforts deploy prevention and care services, including HIV and hepatitis testing, access to pre-exposure prophylaxis (PrEP), treatment referrals, and social service support. The model builds on lessons learned from the 2015 HIV outbreak in rural Scott County, Indiana, where a coordinated "one-stop shop" approach helped curb transmission through testing, treatment referrals, care coordination, and social services.
- The Edgecombe County Post Overdose Response Team in North Carolina expands the role of EMS providers beyond emergency response to address substance use and related health risks. Paramedics conduct post-overdose follow-ups and community outreach to connect individuals with healthcare, recovery services, and social supports. The program also offers mobile testing for HIV, hepatitis C, and syphilis, along with referrals to treatment, addressing infectious disease alongside with overdose prevention.
Considerations for Implementation
When implementing a rural infectious disease prevention program, key considerations include delivery setting, timing of service delivery, and staff cross-training.
Delivery setting. Rural infectious disease prevention programs are most effective when services are delivered in settings people already use, such as primary care clinics, emergency departments, EMS encounters, health departments, and mobile outreach. Coordinating or co-locating services, such as vaccination, testing, and overdose prevention, helps reduce missed opportunities and improves linkage to specialty care. This approach also addresses common rural challenges including limited workforce and transportation barriers.
Timing of service delivery. Programs should offer hepatitis A and B vaccination at the first point of contact whenever possible, rather than requiring separate appointments. Strategies such as standing orders, walk-in access, tracking multi-dose completion, and pairing vaccines with services like HIV testing or naloxone distribution can increase uptake and reduce barriers.
Staff cross-training. Because rural communities often have limited access to infectious disease and addiction specialists, programs may need to rely on cross-trained generalist staff and providers who can deliver multiple services. Primary care clinicians, nurses, pharmacists, case managers, and peer staff can be trained to:
- Conduct basic risk screening
- Provide vaccine counseling
- Offer HIV and hepatitis testing,
- Deliver brief safer-use education
- Link individuals to treatment
Cross-training allows multiple prevention and care needs to be addressed during a single visit, rather than requiring multiple referrals.
Program Clearinghouse Example
Resources to Learn More
Infectious Diseases in Persons Who
Inject Drugs
Website
Summarizes information about infectious diseases associated with drug use. Topics covered include HIV, viral
hepatitis, and other infections linked to unsafe injection practices, as well as prevention strategies and
access to health services for people who inject drugs.
Organization: Centers for Disease Control and Prevention
Infectious
Disease Prevention and Control
Website
Provides resources and tools to support local health departments in efforts to prevent and control infectious
disease. Information shared includes infectious prevention practices, workforce training, outbreak response,
epidemiology capacity building, and partnerships to strengthen community health systems.
Organization: National Association of County and City Health Officials
HIV and Substance
Use
Website
Highlights information on the relationship between HIV and substance use including how drug use can increase HIV
risk through behaviors such as sharing injection equipment.
Organization: National Institutes of Health