Comprehensive Care for People Who Use Drugs: Combining Infectious Diseases Services, Harm Reduction, and Primary Care.

Abstract

Background: People who use drugs (PWUD) have not only increased risk of infectious diseases but also low uptake of primary care. Community-based harm reduction (HR) programs are trusted sources of care among this vulnerable population. Expansion of services offered through these programs may improve access and engagement; we assessed uptake of services within a pilot program in Chicago that offered comprehensive primary care, infectious diseases consultation, and substance use disorder (SUD) and HR services.

Methods: PWUD seeking HR services were referred by outreach workers with lived SUD experiences to primary care and infectious diseases providers embedded in the HR program. We reviewed all clinical encounters occurring from 19 October 2018 to 31 December 2021. We assessed patient demographics and visit types and determined the number of encounters for those with and without SUD. We compared characteristics of encounters for individuals with and without SUD using χ² tests and Wilcoxon rank sum tests.

Results: Over the study period, services were rendered to 552 unique patients in 1720 clinical encounters. Patients were predominantly male (70.7%), their median age was 43 years (IQR, 19-71), and 75.2% had public insurance. Care for active SUD made up a sizable majority of encounters (n = 1227, 71.3%), and nearly a quarter of these addressed infections often associated with PWUD. Encounters addressing hepatitis C and HIV represented 20% of all encounters.

Conclusions: Colocating primary care and infectious diseases services in a community-based HR program in Chicago allowed for high utilization of critical health care offerings by PWUD. This comprehensive care model helps address the unique needs of this population while mitigating common barriers to care.