Support to Address the Infectious Disease Consequences of the Opioid Crisis

The United States is currently facing an urgent crisis involving the use and misuse of opioids such as heroin, illicitly manufactured fentanyl, and prescription opioids – as well as the use of other drugs such as methamphetamines and cocaine. Not only were there more than 70,000 drug overdose deaths in 20171 , but this crisis is also fueling a dramatic increase in infectious diseases. The number of new hepatitis C infections has more than tripled since 2010, with an estimated 44,000 people newly infected and 17,253 associated deaths in 2017. Since 2014, new hepatitis B infections have increased, with 32 states reporting increases in acute infections in adults over 40 years old in 20172. Further, outbreaks of viral hepatitis, as well as HIV, among people who inject drugs continue throughout the country.

In the Department of Defense and Labor, Health and Human Services, and Education Appropriations Act, 2019 and Continuing Appropriations Act, 2019external icon, CDC was appropriated $5 million in funding for the Infectious Disease and the Opioid Epidemicexternal icon initiative to respond to this public health threat. With these funds, CDC is increasing testing for viral hepatitis and linkage to care among people who inject drugs in high-impact settings such as syringe services programs and emergency departments. CDC is also supporting efforts to strengthen comprehensive syringe services programs (SSPs) – a proven, effective component of community-based programs working to prevent the spread of infectious disease from injection drug use and link people to substance use disorder treatment. Several projects tied to the Infectious Disease and the Opioid Epidemicexternal icon initiative — supported by complementary funds leveraged from the Opioid Overdose Prevention and Surveillancepdf icon initiative – began in FY 2019.

First, the National Harm Reduction Technical Assistance and Syringe Services Program (SSP) Monitoring and Evaluation Funding Opportunity (CDC-RFA-PS19-1909)external icon builds capacity in syringe services programs across the nation by providing technical assistance, and also enhances monitoring and evaluation programs. With additional investment, syringe services programs could be augmented nationwide. Two grantees have been awarded funds as part of this program: one project will improve linkages to opioid use disorder and infectious disease care for SSP clients, and the other will facilitate learning more about risk practices among people who inject drugs for the purpose of better serving them. Grantees include the following:


Awardee Name: National Alliance of State and Territorial AIDS Directors (NASTAD)
Total Funding for Three-Year Program: $3,550,000 (year one at $1,850,000; years two and three at $850,000)
Summary of Project: NASTAD will develop a national network that provides harm reduction technical assistance responsive to the needs of states and local jurisdictions. Over three years, NASTAD will create a toolkit to support the implementation of SSPs in urban, suburban, and rural areas. NASTAD will also implement a demonstration project focused on patient navigation at eight syringe services programs to link clients to medication-assisted therapy and to treatment for infectious disease.


Awardee Name: University of Washington
Total Funding for Three-Year Program: $3,375,000 (year one at 3,125,000; years two and three at $125,000)
Summary of Project: University of Washington will develop national standardized metrics for monitoring syringe services programs. They will work with programs to improve program data collection and reporting for local monitoring and evaluation. This work will lead to the development of a national monitoring and evaluation program for SSPs. University of Washington will also conduct a demonstration project to develop a survey instrument to collect individual-level data from SSP clients and their peers.

CDC’s investment in these programs will strengthen the capacity and improve the performance of SSPs throughout the United States by supporting enhanced technical assistance to ensure the provision of high-quality, comprehensive harm reduction services; implementing a national SSP monitoring and evaluation program; and supporting the development and implementation of best practices for patient navigation from SSPs to community-based health and social services. Activities under this NOFO will also increase our capacity to understand injections drug use and risk in the United States.

Secondly, Infectious Disease and the Opioid Epidemicexternal icon resources supplemented an existing CDC program, Improving Hepatitis B and C Care Cascades: Focus on Increased Testing and Diagnosis (PS 17-1702SUPP)external icon, to increase investments in local communities (via state or city health departments) to test and link people to care in high-impact settings. Funds were awarded on September 1, 2019. Nine jurisdictions were funded, with an average award of $450,000, including:


Awardee Name: California Department of Public Health
Funding Amount: $520,000
Summary of Project: California Department of Public Health (CDPH) will partner with high burden areas in one high prevalence jurisdiction (Orange County) and two highly vulnerable jurisdictions (Plumas County and Lake County). CDPH propose focusing on high burden areas within the state that have been identified as highly vulnerable to the rapid increase of HIV and HCV transmission related to non-sterile injection drug use. More specifically, this project aims to (1) intensify efforts of conducting hepatitis C testing amongst persons who inject drugs, and (2) ensure that persons diagnosed with HCV infection are linked to appropriate medical care.


Awardee Name: District of Columbia Department of Health
Funding Amount: $520,000
Summary of Project: DC Health intends to mount a comprehensive data-to-cure approach to sort through surveillance data and identify individuals who have been diagnosed with hepatitis and create paths to help these individuals access treatment. People who inject drugs and DC residents who were previously diagnosed and may not have accessed treatment and possible cure after diagnosis will be the prioritized population for this project. DC Health intends to collaborate with internal/external partners, hospitals, and stakeholders to (1) increase hepatitis B and hepatitis C testing and diagnosis, (2) increase awareness of HBV and HCV infection among people who inject drugs, (3) increase linkage to appropriate medical care for people living with HBV and HCV infection, and (4) increase linkage to substance use treatment and other prevention activities for people who inject drugs.


Awardee Name: Louisiana Office of Public Health STD/HIV/ Hepatitis Program
Funding Amount: $450,000
Summary of Project: Approximately 40,263 people with an HCV diagnosis were reported to the Louisiana Department of Health’s (LDH) Office of Public Health in the past 10 years. It is well established that diagnosed and reported cases may only account for half of true HCV prevalence. In response to the current crisis, LDH has created a first of its kind subscription model for universal provision of antiviral treatment to persons receiving Medicaid and people who are currently incarcerated. This supplemental funding mechanism will allow LDH to take full advantage of newly established unfettered to HCV treatment in Louisiana’s Project HEPConnect program. Resources will be invested to greatly enhance ability to test, diagnose, link to cure and ultimately halt the transmission of HBV and HCV in the state correctional system through the delivery of a highly coordinated, population-based screening and treatment model. Additionally, LDH in conjunction with Louisiana Department of Corrections, will provide voluntary (opt-out) testing of incarcerated persons housed within the eight state prisons and two parish jails who are not aware of their HCV/HBV status.


Awardee Name: Michigan Department of Health and Human Services
Funding Amount: $450,000
Summary of Project: Michigan has an HCV prevalence of 69,100 which ranks seventh among all states in the United States. In recent years there has been an increase in HCV diagnoses in young persons, largely driven by the opioid crisis. Michigan Department of Health and Human Services will partner with four high impact settings to increase HCV testing and linkage to care among persons who inject drugs – two syringe services programs serving rural and highly vulnerable areas of Michigan, and in two specific counties (Chippewa and Marquette).


Awardee Name: New York City Department of Health and Mental Hygiene
Funding Amount: $520,000
Summary of Project
: In 2018 in New York City (NYC), the rate of people newly reported with hepatitis C in the correctional health system was 404.7 per 100,000 persons, compared with 56.5 per 100,000 persons overall. During 2017-2018 alone, the top three hepatitis C-reporting substance use treatment centers in NYC reported over 5,000 people with hepatitis C. New York City Department of Health and Mental Hygiene will use a data-driven approach to implement quality improvement projects and build capacity for community-based hepatitis C testing, linkage to care, and navigation services in organizations serving people who inject drugs.


Awardee Name: Oregon Health Authority
Funding Amount: $450,000
Summary of Project: There is an unmet need for development of service models to address the needs of people who inject drugs in rural settings. Oregon Health Authority (OHA) proposes to pilot the use of peer wellness navigators based in high-risk counties to help them identify and serve people who inject drugs in three geographically large but sparsely populated counties (Klamath County in Southern Oregon, and Umatilla and Malheur County in Northeast Oregon). OHA will expand screening for HBV and HCV using a peer-based model.


Awardee Name: Rhode Island Department of Health
Funding Amount: $450,000
Summary of Project: RI DOH will screen people who inject drugs for HBV/HCV to diagnose those who are unaware of their infection, link individuals who test positive for HBV/HCV to appropriate medical care, provide treatment to those who have chronic HBV/HCV, and vaccinate susceptible individuals against HBV.


Awardee Name: South Carolina Department of Health and Environmental Control
Funding Amount: $450,000
Summary of Project: The SC Department of Health and Environmental Control (SCDHEC) will increase testing, diagnosis and linkage to care for HBV and HCV infections among people who inject drugs by partnering with high-impact settings to conduct target testing, diagnosis and linkage to care activities to people who inject drugs in high burden counties . SCDHEC propose to expand existing partnerships to increase partner HIV counseling, testing and linkage to care services to include HBV and HCV. This targeted testing will be conducted in high burden areas and high impact settings where people who inject drugs are accessible which will effectively identify and address cases of HBV and HCV.


Awardee Name: West Virginia Department of Health and Human Services
Funding Amount: $227,381
Summary of Project: WV DHHS’s 2019 situational analysis identified five rural, high burden counties that are targeted for increased testing and linkage to care (Cabell, Logan, McDowell, Raleigh, and Wyoming). The continued rise in reports of acute, chronic, and perinatal HBV and HCV infections has been attributed to increasing illicit drug use. This increase may also be a result of better disease detection and improved surveillance. WV DHHS will increase testing and link positive patients to care for HBV/HCV to appropriate education and care.

1Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and Opioid-Involved Overdose Deaths — United States, 2013–2017. MMWR Morb Mortal Wkly Rep 2019;67:1419–1427. DOIexternal icon
2 Surveillance for Viral Hepatitis, United States, 2017

Page last reviewed: October 11, 2019