Nolan Nathanial S, Fracasso Francis Sarah M, Marks Laura R, Beekmann Susan E, Polgreen Philip M, Liang Stephen Y, Durkin Michael J
Division of Infectious Disease, VA St Louis Health Care, St Louis, Missouri, USA.
Division of Infectious Disease, Washington University School of Medicine, St Louis, Missouri, USA.
Open Forum Infect Dis. 2023 Jul 25;10(8):ofad402. doi: 10.1093/ofid/ofad402. eCollection 2023 Aug.
The rise in injection drug use (IDU) has led to an increase in drug-related infections. Harm reduction is an important strategy for preventing infections among people who inject drugs (PWID). We attempted to evaluate the harm reduction counseling that infectious diseases physicians provide to PWID presenting with infections.
An electronic survey was distributed to physician members of the Emerging Infections Network to inquire about practices used when caring for patients with IDU-related infections.
In total, 534 ID physicians responded to the survey. Of those, 375 (70%) reported routinely caring for PWID. Most respondents report screening for human immunodeficiency virus (HIV) and viral hepatitis (98%) and discussing the risk of these infections (87%); 63% prescribe immunization against viral hepatitis, and 45% discuss HIV preexposure prophylaxis (PrEP). However, 55% of respondents (n = 205) reported not counseling patients on safer injection strategies. Common reasons for not counseling included limited time and a desire to emphasize antibiotic therapy/medical issues (62%), lack of training (55%), and believing that it would be better addressed by other services (47%). Among respondents who reported counseling PWID, most recommended abstinence from IDU (72%), handwashing and skin cleansing before injection (62%), and safe disposal of needles/drug equipment used before admission (54%).
Almost all ID physicians report screening PWID for HIV and viral hepatitis and discussing the risks of these infections. Despite frequently encountering PWID, fewer than half of ID physicians provide safer injection advice. Opportunities exist to standardize harm reduction education, emphasizing safer injection practices in conjunction with other strategies to prevent infections (eg, HIV PrEP or hepatitis A virus/hepatitis B virus vaccination).
注射吸毒（IDU）现象的增加导致了与毒品相关感染的增多。减少伤害是预防注射吸毒者（PWID）感染的一项重要策略。我们试图评估传染病医生为出现感染症状的注射吸毒者提供的减少伤害咨询服务。
向新兴感染网络的医生成员发放了一份电子调查问卷，以询问在照顾与注射吸毒相关感染患者时所采用的做法。
共有534名传染病医生回复了该调查。其中，375名（70%）报告经常照顾注射吸毒者。大多数受访者报告对人类免疫缺陷病毒（HIV）和病毒性肝炎进行筛查（98%）并讨论这些感染的风险（87%）；63%的人开具病毒性肝炎免疫接种处方，45%的人讨论HIV暴露前预防（PrEP）。然而，55%的受访者（n = 205）报告未就更安全的注射策略向患者提供咨询。未提供咨询的常见原因包括时间有限以及希望强调抗生素治疗/医疗问题（62%）、缺乏培训（55%）以及认为其他服务能更好地解决这一问题（47%）。在报告为注射吸毒者提供咨询的受访者中，大多数建议戒除注射吸毒（72%）、注射前洗手和清洁皮肤（62%）以及安全处置入院前使用过的针头/毒品用具（54%）。
几乎所有传染病医生都报告对注射吸毒者进行HIV和病毒性肝炎筛查并讨论这些感染的风险。尽管经常接触注射吸毒者，但不到一半 的传染病医生提供更安全的注射建议。存在规范减少伤害教育的机会，应结合其他预防感染的策略（如HIV PrEP或甲型肝炎病毒/乙型肝炎病毒疫苗接种）强调更安全的注射做法。
