WHO guidance on integrated care for people who inject drugs

People who use drugs are at increased risk of TB, with rates documented in the pre-AIDS era of over 10 times higher than among the general population. HIV further increases the risk of TB, and TB is a leading AIDS-defining illness and cause of mortality among people living with HIV who inject drugs. The convergence of viral hepatitis, HIV, TB and injecting drug use has become a major health concern and can have important implications for case management.

WHO strongly supports harm reduction as an evidence-based approach to caring for people who inject drugs and has defined a comprehensive package of harm reduction which includes the prevention, diagnosis and treatment of tuberculosis as a core component. The latest WHO guidance on integrated care for people who inject drugs can be accessed here.

Overview of the WHO consolidated guidelines

The guidelines aim to reduce morbidity and mortality related to TB and HIV-associated TB among people who inject drugs (PWID) through the integrated delivery of a comprehensive and holistic package of care. The guidelines provide an update of the 2008 Policy guidelines for collaborative TB and HIV services for injecting and other drug users: an integrated approach. They consolidate the latest recommendations relating to the management of TB, HIV-associated TB, HIV, viral hepatitis B and hepatitis C, and drug dependence, as well as of alcohol dependence, malnutrition, mental illness and psychosocial needs. Although the main focus of this guidance is to benefit PWID, many of the recommendations are also relevant for those who use drugs and do not currently inject, but are in need of the respective services.

The guidelines are intended primarily for policy-makers and decision-makers in the field of health, in both the civilian and penitentiary systems. These include managers of TB, HIV, and viral hepatitis programmes or their equivalents as well as drug dependence treatment services, and other essential WHO-recommended core services for PWID (e.g. NSPs) in the governmental or nongovernmental sectors.

Developed on a basis of human rights principles, the guidelines are structured around the following three objectives:

• establish and strengthen mechanisms for the integrated delivery of services for PWID;
• reduce the joint burden of TB, HIV, viral hepatitis and other comorbidities among PWID through the integrated delivery of comprehensive services; and
• ensure a standard of health care in prisons equivalent to that found outside prisons through harmonization of interventions and linkage to services in the community.

Source: WHO