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Implementation of an integrated infectious disease and substance use disorder team for injection drug use-associated infections: a qualitative study

People who inject drugs are not only vulnerable to infectious diseases but also face greater stigmatization as substance users. This becomes a barrier to seeking medical assistance for severe drug-use-related infections (SIRIs). This research was conducted to identify patient- and clinician-level perceived implementation barriers and facilitators to the SIRI team intervention.

Semi-structured qualitative interviews guided by the Consolidated Framework for Implementation Research were conducted among healthcare clinicians and patients with a history of SIRI. Implementation barriers to the SIRI team intervention identified by participants included: (1) complexity of the SIRI team intervention; (2) lack of resources for PWID experiencing homelessness, financial insecurity, and uninsured status; (3) clinician-level stigma and lack of knowledge around addiction and medications for opioid use disorder (OUD); and (4) concerns about underinvestment in the intervention. Implementation facilitators of the intervention included: (1) a non-judgmental, harm reduction-oriented approach; (2) the team’s advocacy for PWID as a means of institutional culture change; (3) provision of close post-hospital follow-up that is often inaccessible for PWID; (4) strong communication with patients and their hospital physicians; and (5) addressing diverse needs such as housing, insurance, and psychological wellbeing.  Integration of infectious disease and SUD treatment is a promising approach to managing patients with SIRIs. Implementation success depends on institutional buy-in, holistic care beyond the medical domain, and an ethos rooted in harm reduction across multilevel (inner and outer) implementation contexts.


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