This miniguide on responding to drug-related infectious diseases is one of a larger set, which together comprise Health and social responses to drug problems: a European guide 2021. The guide supports practitioners and policymakers in tackling the negative consequences of drug use. This miniguide provides an overview of the most important aspects to consider when planning or delivering health and social responses to drug-related infectious diseases, and reviews the availability and effectiveness of the responses. It also considers implications for policy and practice.

Key issues
The sharing of injecting equipment increases the risk of transmitting and acquiring blood-borne infections, such as HIV and hepatitis B and C viruses (HBV and HCV). Marginalised groups, including people with serious drug problems, whether or not they inject, may also be at increased risk of contracting other infectious diseases, such as tuberculosis.

Hepatitis C is the most prevalent blood-borne viral infection among people who inject drugs. The availability of highly effective treatments for hepatitis C has led to a shift in focus towards addressing the high rates of HCV infection found among people who inject drugs. Chronic HCV infection can result in death from severe liver disease, such as cirrhosis and liver cancer.

Historically, interventions targeting people who inject drugs – primarily opioid agonist treatment, needle and syringe programmes and harm reduction measures to reduce risk behaviours – were mainly focused on reducing HIV transmission. The success of these measures can be seen in the low proportion of HIV transmission attributed to drug injecting (about 5 % of diagnoses for which the route of transmission is known), a rate which has been stable for the past decade. Nevertheless, the risk of HIV infection associated with injecting drug use remains high in some countries, and injecting-related HIV outbreaks still occur in Europe.

Evidence and responses

• Providing opioid agonist treatment and other effective drug dependence treatment to people who inject drugs.
• Needle and syringe programmes providing sterile injection equipment and education on safer use to people who inject drugs.
• Vaccinating against hepatitis A and B, tetanus, influenza and COVID-19, in addition to making the pneumococcal vaccine available to at-risk individuals.
• Routine testing for HIV, HCV (plus HBV for those who are unvaccinated), and other infections such as tuberculosis, integrated into drug treatment and harm reduction services.
• Referral and treatment provision for those found to be infected, including direct-acting antiviral treatments for HCV.
• Health promotion focused on safer injecting behaviour, sexual health (including condom use), and disease prevention, testing and treatment.
• Individual interventions using proactive, multi-component approaches that are adapted to user needs and local conditions.