Drug Abuse Related Infectious Diseases

Testing for drug-related infectious diseases among people who inject drugs (PWID) is crucial. Early diagnosis through testing, and improving links to treatment and care, are essential steps towards reaching global health goals.

HIV and chronic viral hepatitis are highly prevalent among people who inject drugs, transmitted through the sharing of injecting equipment, such as needles and syringes. Viral hepatitis, particularly infection caused by the hepatitis C virus (HCV), is highly prevalent among PWID. Without access to treatment, many will develop a chronic infection, which can lead to liver cirrhosis and cancer. Harm reduction services are often the first point of entry for diagnosis and links to treatment play an essential role in preventing new or recurring infections. While outbreaks of HIV and bacterial infections among PWID are relatively rare, they continue to be reported, and injecting stimulant drugs may be an important risk factor for these infections.

Because of the nature of risk exposures that often accompany addiction, such as injecting drug use, drug sharing, or sex work, nurses and healthcare professionals should consider blood-borne viruses as part of a person’s health picture. A nursing or general health assessment also creates an opportunity to provide a protective vaccination against Hepatitis B.

Depending on the prevalence rate in individual countries, the sexual transmission rate of HIV and HEP B may be higher or lower, there are other factors to consider when considering sexual transmission. Biological factors such as viral load, and sexual practices may result in increased transmission. While we know that vertical transmission, where a pregnant mother passes the virus on to her unborn child, carries the highest-burden on incidence in many countries, other exposures such as particular cohort, for example, men who have sex with men, multiple sexual partners and drug-injecting use should be considered. PWID may thus form pockets of infection for continued transmission to the wider population. An efficient way of preventing sexual transmission is the use of condoms. Condom use has greatly increased among people who use drugs, especially among sex workers who usually report high rates of condom use with their clients. However, condom use is usually low with private partners who therefore remain a major risk group for infection.

One of the biggest barriers to clients engaging in treatment for HIV, Hepatitis B, or Hepatitis C is fear and shame. To gain real and meaningful engagement regarding these blood-borne viruses or BBVs, it is crucial to remember that a large proportion of people in addiction have experienced all sorts of traumas.

There are two main opportunities to identify clients who may be at risk of BBVs. One is to deliberately target any clients with addiction problems and the second is to take advantage of clinical opportunities. An opportunity to address BBVs may arise for a nurse or healthcare professional when they are dressing a wound which may be a suspected abscess from injecting. Observing track marks from injecting when the nurse is taking a blood sample or measuring blood pressure is another opportunity to address BBVs and possible testing. A further opportunity might arise if a patient requests a condom or the morning after pill. These requests could also indicate exposure to a BBV risk and an opportunity to engage in a discussion of potential testing and treatment.

With all patients, it is important to understand how to identify risks for BBV’s, how to give pre-test advice using appropriate language, and to have an awareness of a patient’s past trauma. Finally, if testing is to be recommended it is important to have established a referral pathway for your potential patients. [Ask a prompt question here for learners to start a conversation about the topic in the Comments section. Reflecting on your own practice, have there been occasions where you have missed an opportunity to engage a client in a conversation about their possible exposure to blood-borne viruses or other infections such as TB.

In the next step, we will hear from Nurse Specialist Jean Flanagan and Peter Kelly discussing their experiences in working with clients affected by BBVs and how you can best approach these sensitive topics with your clients.

References

<sup>46. EMCDDA. Increase access to hepatitis C (HCV) testing and care in drug services — a toolkit2021. Available from: https://www.emcdda.europa.eu/toolkit/hepatitis-C-testing-and-care-in-drugs-services_en.
47. World Health Organization. Interim guidance for country validation of viral hepatitis elimination. Geneva; 2021.
48. World Health Organization. Recommendations and guidance on hepatitis C virus self-testing. Geneva: World Health Organization; 2021.
49. World Health Organization. Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021. Geneva; 2021.</sup>