Seven ways to reduce infections among people who inject drugs

In a new guidance document, EU agencies European Centre for Disease Prevention and Control (ECDC) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) have joined forces to identify seven interventions to reduce and prevent infectious diseases in this vulnerable population. Many European countries have achieved substantial progress in recent years in preventing drug-related infections. Drug injecting, however, remains a major cause of infectious diseases across Europe. The interventions proposed range from the supply of injection equipment, testing and vaccination to the treatment of infections and drug dependence. These are best applied in combination and ideally in the same venue for maximum effect.

The ECDC–EMCDDA joint publication is published together with a ‘Guidance in brief’ summary and with two technical reports providing a full assessment of the evidence (coming soon). The seven recommended interventions are:

• Injection equipment: Provide free access to clean drug injection equipment, including sterile needles and syringes, as part of combined multi-component prevention, harm-reduction, counselling and treatment programmes.
• Vaccination: Offer vaccinations for infections for which effective vaccines exist, such as hepatitis A, B, tetanus and influenza. For HIV-infected individuals, the pneumococcal vaccine is also recommended.
• Drug dependence treatment: Provide access to treatment, in particular substitution treatment for opioid users.
• Testing: Grant access to testing for HIV, hepatitis C and hepatitis B and other infections, including tuberculosis; ensure the link to treatment.
• Infectious disease treatment: Provide antiviral treatment as clinically indicated for HIV-, hepatitis B- or hepatitis C-infected. Tuberculosis treatment is recommended for active cases, while prophylactic therapy should be considered for latent cases.
• Health promotion: Provide health promotion focused on safer drug use and sexual behaviour to enable people to increase their ability to control and improve their health.
• Targeted delivery of services: Offer a range of services, delivered according to user needs and local conditions, such as drug treatment, harm reduction, counselling and testing and referrals to other medical services.

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