Integrated infectious disease and substance use disorder care for the treatment of injection drug use-associated infections: a prospective cohort study with historical control


 
 
 To address the infectious disease (ID) and substance use disorder (SUD) syndemic, we developed an integrated ID/SUD clinical team rooted in harm reduction at a county hospital in Miami, Florida. The Severe Injection-Related Infection (SIRI) team treats people who inject drugs (PWID) and provides medical care, SUD treatment, and patient navigation during hospitalization and post-hospital discharge. We assessed the impact of the SIRI team on ID and SUD treatment and healthcare utilization outcomes.
 
 
 
 We prospectively collected data on patients seen by the SIRI team. A diagnostic code algorithm confirmed by chart review was used to identify a historical control group of patients with SIRI hospitalizations in the year preceding implementation of the SIRI team. The primary outcome was death or readmission within 90 days post-hospital discharge. Secondary outcomes included initiation of medications for opioid use disorder (MOUD) and antibiotic course completion.
 
 
 
 There were 129 patients included in the study: 59 in the SIRI team intervention and 70 in the pre-SIRI team control group. SIRI team patients had a 45% risk reduction (aRR = 0.55, 95% CI: [0.32, 0.95]; 24% vs. 44%) of being readmitted in 90 days or dying compared to pre-SIRI historical controls. SIRI team patients were more likely to initiate MOUD in the hospital (93% vs. 33%, p < 0.01), complete antibiotic treatment (90% vs. 60%, p < 0.01), and less likely to have patient-directed discharge (17% vs 37%, p = 0.02).
 
 
 
 An integrated ID/SUD team was associated with improvements in healthcare utilization, MOUD initiation, and antibiotic completion for PWID with infections.
