Infectious Diseases
Infectious disease screening services are critical to any comprehensive strategy, including offering brief interventions and providing referrals, to reduce and eliminate infections among people at an increased risk for viral hepatitis, Human Immunodeficiency Virus (HIV), and bacterial and fungal infections through sharing needles and drug-preparation equipment. These services identify those who are unaware of their infections, provide them with counseling and education, and refer and link them to treatment. Additionally, increased knowledge of infection status may help individuals make behavioral changes to reduce infection risk and reduce the likelihood of transmission to others.
Infectious Diseases and Opioid Use Disorder (OUD) [PDF - 156 KB]
Infectious Diseases and Opioid Use Disorder (OUD) Policy Issues and Recommendations Approved: March 2018 [PDF - 566 KB] – from Infectious Diseases Society of America (IDSA), the HIV Medicine Association (HIVMA), and the Pediatric Infectious Diseases Society
Health-care providers should also routinely (i.e., at baseline, periodically, and as clinically indicated) obtain sexual histories from their patients and discuss harm reduction strategies. High-intensity behavioral counseling is recommended for all sexually active adolescents and for adults at increased risk Sexually Transmitted Infections (STIs) and HIV infection. Questions to identify risk related to illicit use of drugs include questions on whether the patients have ever injected drugs illicitly or have partners who have exchanged sex or money for illicit drugs. Persons seeking treatment or screening for a particular STI should be evaluated for all common bacterial and fungal STIs (i.e., chlamydia, gonorrhea, syphilis, and trichomoniasis) and informed if testing for any common STI has not been performed. Although no comprehensive national guidelines regarding STI care and management have been developed for correctional populations, the utility of expanded STI services in correctional settings has been reported.
The CDC offers additional resources on STIs and STI Treatment Guidelines .
The CDC recommends everyone between the ages of 13 and 64 get tested for HIV at least once. For people with certain risk factors, including those who have a history of shared needles, syringes or other injection drug equipment, should be tested annually. The CDC offers HIV prevention resources and IHS has specific information available to American Indian/Alaska Native communities on the IHS HIV/AIDS site.
Tens of thousands of people are newly infected with viral hepatitis every year in the United States. It is a serious public health threat that kills thousands of Americans annually and is a leading cause of liver cancer. Hepatitis A and Hepatitis B are vaccine-preventable and Hepatitis C can be cured.
Hepatitis A Virus (HAV) & Hepatitis B Virus (HBV)
Hepatitis B vaccination is recommended for people who use substances. Providers should obtain a thorough history to identify patients who may benefit from HAV and HBV vaccination. Implementation strategies to overcome barriers and increase coverage, including the use of standing orders should be considered.
People who use substances should also be offered screening and counseling for chronic HBV infection. Testing should include a serologic assay for hepatitis B surface antigen (HBsAg), offered as a part of routine care, and if the result is positive, be accompanied by appropriate counseling and referral for recommended clinical evaluation and care. Previous and current sex partners and household and needle-sharing contacts of HBsAg-positive persons should be identified. Susceptible persons (i.e., those who have tested negative for HBsAg and anti-HBc) should complete an age-appropriate vaccine dose and schedule. Those who have not been vaccinated fully should complete the vaccine series to prevent infection from ongoing exposure.
Medical providers should advise patients identified as HBsAg-positive about measures they can take to prevent transmission to others and protect their health.
Hepatitis C Virus (HCV)
There is no vaccination for HCV, but with the recent advancements in HCV treatment, it is recommended that all persons with HCV infection be treated and cured of the infection.
All persons who use substances should routinely be offered screening and counseling for HCV infection, with those using via injection at greatest risk. Persons with a history of risk, such as those who injected illicitly once or many years ago, should be offered screening and counseling for HCV infection. Facilities that provide counseling and testing should include services or referrals for medical evaluation and management of those identified as infected with HCV.
For more information from IHS, visit our Hepatitis C page.
Targeted testing programs should be considered for persons at high risk for TB infection, including persons who use substances. All persons suspected of having had a recent exposure to someone with active TB should be screened.
Screening and treatment of sexually transmitted infections should be considered as part of a comprehensive harm reduction strategy. Recommendations for screening vary based on age, pregnancy status, behaviors, and gender identity. To review current screening recommendations, visit the CDC’s Sexually Transmitted Infection Treatment Guideline, 2021.
