A holistic approach to drug user health – a communicable disease perspective

Sarah Hess, Virginia Macdonald, Annette Verster, Annabel Baddeley

Issue – People who inject drugs are disproportionately affected by communicable diseases including HIV, hepatitis C (HCV) and tuberculosis. Globally, coverage of comprehensive services to promote drug user health and access to harm reduction remains at levels too low for it to be effective from a public health perspective. This is due to a lack of political will, insufficient global and national funding and missed opportunities for combined disease programming and integration.

Setting -HIV and HCV coinfection rates reach 100% among PWID in some countries. HIV infection increases the risk of TB and MDR-TB among PWID. In high burden TB countries at least two thirds of PWID who develop TB are estimated to be HCV positive. Yet, programming for HIV, hepatitis and TB has traditionally been implemented vertically with reliance on donor funding predominantly linked to HIV.

Key arguments – Opportunities exist for TB, HIV and hepatitis programmes to ensure integrated and comprehensive services for PWID within national health systems and under the framework of universal health coverage (UHC). This promotes a holistic approach to drug user health without focusing on disease-specific policies or interventions but rather health as a human right for a population with multiple needs. Opportunities include expanding the evidence base through interdisciplinary research; combined advocacy efforts; leveraging universal health coverage for PWID; implementing a comprehensive package of services that includes but is not limited to harm reduction; measuring, evaluating and identifying good practices; and delivering comprehensive services in a way that is endorsed by the affected community.

Implications – UHC provides an opportunity to mainstream communicable disease programming within an integrated, comprehensive and sustainable approach to drug user health as recommended by WHO. This will require collaboration, partnerships and active engagement of all stakeholders, including policy makers, implementers, programme managers, service users and academia.