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Introduction A recent surge in HIV outbreaks, driven by the opioid and stimulant use crises, has destabilized our progress toward targets set forth by Ending the HIV Epidemic: A Plan for America for the high-priority community of people who inject drugs (PWID), particularly Black PWID. Methods In order to ascertain the acceptability and feasibility of using a mobile syringe services program (SSP) for comprehensive HIV prevention via PrEP and medications for opioid use disorder (MOUD), our mixed methods approach included a quantitative assessment and semi-structured qualitative interviews with Black PWID ( n  = 30) in Miami-Dade County who were actively engaged in mobile syringe services. Results Participants felt that delivery of MOUD and PrEP at a mobile SSP would be both feasible and acceptable, helping to address transportation, cost, and stigma barriers common within traditional healthcare settings. Participants preferred staff who are compassionate and nonjudgmental and have lived experience. Conclusions A mobile harm reduction setting could be an effective venue for delivering comprehensive HIV prevention services to Black PWID, a community that experiences significant barriers to care via marginalization and racism in a fragmented healthcare system.

People who inject drugs (PWID) are at an increased risk for HIV infection due to injection and sexual risk behaviors. This study aims to examine PrEP knowledge, awareness, and willingness to be linked to PrEP services at a syringe services program (SSP), and examine the relationship between substance use and interest in PrEP linkage. Data were collected using a cross-sectional survey of IDEA SSP clients in Miami, FL (N = 157). Based on reported substance injected, participants were classified into opioid-only injection or polysubstance injection. Socio-demographics and HIV risk were examined using Pearson's Chi-Squared analysis. Bivariate and multivariable logistic regression models were used to test for significant correlates of interest in PrEP linkage. Only 28.3% of PWID surveyed had previously heard of PrEP. However, 57.2% were interested in receiving more information about PrEP. In the adjusted model, people with opioid-only use were significantly less likely to report interest in being linked to PrEP. Knowledge, awareness, and interest in being linked to PrEP were low among PWID surveyed. No participants of the study were successfully linked to PrEP services through direct referrals. Further research is needed to examine low threshold service delivery of PrEP to PWID at SSPs.

Objectives The COVID-19 pandemic led to the closure of the IDEA syringe services program medical student-run free clinic in Miami, Florida. In an effort to continue to serve the community of people who inject drugs and practice compassionate and non-judgmental care, the students transitioned the clinic to a model of TeleMOUD (medications for opioid use disorder). We describe development and implementation of a medical student-run telemedicine clinic through an academic medical center-operated syringe services program. Methods Students advertised TeleMOUD services at the syringe service program on social media and created an online sign-up form. They coordinated appointments and interviewed patients by phone or videoconference where they assessed patients for opioid use disorder. Supervising attending physicians also interviewed patients and prescribed buprenorphine when appropriate. Students assisted patients in obtaining medication from the pharmacy and provided support and guidance during home buprenorphine induction. Results Over the first 9 weeks in operation, 31 appointments were requested, and 22 initial telehealth appointments were completed by a team of students and attending physicians. Fifteen appointments were for MOUD and 7 for other health issues. All patients seeking MOUD were prescribed buprenorphine and 12/15 successfully picked up medications from the pharmacy. The mean time between appointment request and prescription pick-up was 9.5 days. Conclusions TeleMOUD is feasible and successful in providing people who inject drugs with low barrier access to life-saving MOUD during the COVID-19 pandemic. This model also provided medical students with experience treating addiction during a time when they were restricted from most clinical activities.

Background Hospitalizations for severe injection drug use-related infections (SIRIs) are characterized by high costs, frequent patient-directed discharge, and high readmission rates. Beyond the health system impacts, these admissions can be traumatizing to people who inject drugs (PWID), who often receive inadequate treatment for their substance use disorders (SUD). The Jackson SIRI team was developed as an integrated infectious disease/SUD treatment intervention for patients hospitalized at a public safety-net hospital in Miami, Florida in 2020. We conducted a qualitative study to identify patient- and clinician-level perceived implementation barriers and facilitators to the SIRI team intervention. Methods Participants were patients with history of SIRIs (n = 7) and healthcare clinicians (n = 8) at one implementing hospital (Jackson Memorial Hospital). Semi-structured qualitative interviews were performed with a guide created using the Consolidated Framework for Implementation Research (CFIR). Interviews were transcribed, double coded, and categorized by study team members using CFIR constructs. Results 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. Conclusion 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.

Background People who inject drugs (PWID) are at increased risk for viral hepatitis, yet hepatitis A virus (HAV) and hepatitis B virus (HBV) screening and immunization rates remain low. Although offering HAV and HBV services at syringe services programs (SSPs) is effective, few U.S. SSPs currently offer them. Limited qualitative research exists on the advantages and optimization of these services at SSPs. This study explored PWID and SSP staff perspectives regarding barriers to HAV and HBV prevention and care services in traditional healthcare, facilitators for SSP-based provision, and opportunities to improve service delivery. Methods This study was conducted at an SSP in Miami, Florida serving over 2500 PWID annually. Quantitative data on vaccine administration from August 2023 to May 2025 were abstracted from the SSP database. Prior to implementation, in May 2022, we conducted in-depth interviews with 15 PWID and 11 SSP staff. Transcripts were analyzed using codebook thematic analysis in Dedoose. Results From August 2023 to May 2025, the SSP administered 114 HAV and 176 HBV vaccine doses. Qualitative interviews from May 2022 revealed several key findings. Barriers included limited knowledge, stigma and discrimination, resource and transportation challenges, navigation difficulties, and limited prioritization. Facilitators for SSP-based services included the benefits of co-located, on-demand care, and non-stigmatizing and supportive environment. Opportunities for improvement included offering incentives, expanding outreach, and increasing communication. Conclusion PWID face significant barriers to HAV and HBV services in traditional healthcare, including stigma, logistical challenges, and limited awareness of viral hepatitis. Integrating these services into SSPs enhanced accessibility and uptake by leveraging trust, convenience, and harm reduction principles.

Background Xylazine is an increasingly common adulterant in the North American unregulated drug supply that is associated with adverse health outcomes (e.g., skin infections, overdose). However, there are significant knowledge gaps regarding how xylazine was initially identified and how syringe services program (SSP) staff and clients (people who use drugs) responded to its emergence. Methods From June–July 2023, we conducted qualitative interviews with medical (e.g., clinicians) and frontline SSP staff (e.g., outreach workers) and adult clients with a history of injection drug use at a Miami-based SSP. Inductive memos identified emergent codes; thematic analysis involving team consensus established final themes. Results From interviews with SSP staff ( n  = 8) and clients ( n  = 17), xylazine emergence was identified at different times, in various ways. Initially, during summer 2022, clients identified a “tranquilizer-like substance” that worsened sedation and withdrawal and caused wounds. SSP medical staff later identified this adulterant as xylazine by treating new medical cases and through diverse information-sharing networks that included professional societies and news sources; however, frontline SSP staff and clients needed additional educational resources about xylazine and its side effects. With limited guidance on how to reduce harm from xylazine, SSP clients altered their drug consumption routes, reduced drug use, and relied on peers’ experiences with the drug supply to protect themselves. Some individuals also reported preferring xylazine-adulterated opioids and increasing their drug use, including the use of stimulants to avoid over sedation. Conclusions Xylazine’s emergence characterizes the current era of unprecedented shifts in the unregulated drug supply. We found that xylazine spurred important behavioral changes among people who use drugs (e.g., transitioning from injecting to smoking). Incorporating these experiences into early drug warning surveillance systems and scaling up drug-checking services and safer smoking supply distribution could help mitigate significant health harms caused by xylazine and other emergent adulterants.

Background Blood-borne viral infections, such as HIV and hepatitis C (HCV), are common infections among people who inject drugs (PWID). This study aims to determine the prevalence of HIV and HCV infection among PWID accessing the first legal syringe services program (SSP) in the state of Florida, along with examining baseline correlates of HIV and HCV infection. Methods Baseline behavioral enrollment assessments of 837 participants accessing an SSP for the first time were analyzed. Patients self-reporting or testing HIV or HCV positive at the enrollment visit were included. Socio-demographic, drug use, and injection-related risk behaviors in the last 30 days were compared across groups defined by all combinations of HIV and HCV serostatus. Bivariate and multivariable logistic regression models were used to assess correlates of baseline HCV and HIV infection independently. Results Overall prevalence for HCV and HIV infection were 44.4% and 10.2%, respectively. After adjusting for confounders, the most significant correlates of baseline HCV infection were age (aOR = 1.01), lower education level (aOR = 1.13), currently homeless (aOR = 1.16), injecting more than seven times a day (aOR = 1.14), reusing syringes (aOR = 1.18), and sharing injection equipment (aOR = 1.13). The most significant predictors of baseline HIV infection were age (aOR = 1.01), non-Hispanic Black race (aOR = 1.28), Hispanic ethnicity (aOR = 1.12), gay or bisexual orientation (aOR = 1.22), and methamphetamine injection (aOR = 1.22). In addition, heroin injection (aOR = 0.92) was significantly associated with a lower odds of HIV infection. Discussion/conclusion Baseline behavioral predictors differed between HIV infection and HCV infection among participants accessing syringe services. Understanding the risk factors associated with each infection should be considered when developing additional harm reduction interventions tailored for diverse PWID populations served at SSPs.

Background Tele-harm reduction (THR) is a telehealth-enhanced, peer-led, harm reduction intervention delivered within a trusted syringe services program (SSP) venue. The primary goal of THR is to facilitate linkage to care and rapid, enduring virologic suppression among people who inject drugs (PWID) with HIV. An SSP in Miami, Florida, developed THR to circumvent pervasive stigma within the traditional healthcare system. Methods During intervention development, we conducted in-depth interviews with PWID with HIV ( n  = 25) to identify barriers and facilitators to care via THR. We employed a general inductive approach to transcripts guided by iterative readings of the raw data to derive the concepts, themes, and interpretations of the THR intervention. Results Of the 25 PWID interviewed, 15 were in HIV care and adherent to medication; 4 were in HIV care but non-adherent; and 6 were not in care. Themes that emerged from the qualitative analysis included the trust and confidence PWID have with SSP clinicians as opposed to professionals within the traditional healthcare system. Several barriers to treatment were reported among PWID, including perceived and actual discrimination by friends and family, negative internalized behaviors, denial of HIV status, and fear of engaging in care. Facilitators to HIV care included empathy and respect by SSP staff, flexibility of telehealth location, and an overall destigmatizing approach. Conclusion PWID identified barriers and facilitators to receipt of HIV care through the THR intervention. Interviews helped inform THR intervention development, centered on PWID in the destigmatizing environment of an SSP.

Background Women who inject drugs (WWID) face disproportionately higher risks of infectious diseases, reproductive health challenges, and gendered social and structural vulnerabilities compared to men. Despite these elevated risks, most harm reduction programs do not tailor their services to meet the needs of WWID. In Florida, where syringe service programs are relatively new and implemented at the county-level, access remains limited. These gaps are especially pronounced for WWID, who face additional barriers due to restrictive reproductive policies and limited access to gender-responsive care. This study examined gender-related risks among people who inject drugs (PWID) accessing a SSP in Miami, Florida to inform harm reduction service delivery and intervention needs. Methods This study analyzed enrollment data from the first legal SSP in Florida collected from its December 2016 inception through July 2022 (N = 1660). In bivariate analyses, we used chi-square tests to describe differences in sociodemographic, injection drug use (IDU) and sexual behaviors, and infectious disease prevalence between men and women. We used multivariable logistic regression models to estimate associations between gender and IDU behaviors, sexual behaviors, and HIV/HCV prevalence, adjusting for age, race/ethnicity, housing status, and enrollment year. Results Our sample included 1660 participants (26% women). Compared to men, WWID had significantly higher odds of sharing syringes (adjusted odds ratio [aOR] = 1.61, 95% confidence interval [CI], 1.23–2.10), injecting over five times per day (aOR = 1.33, CI 95%, 1.05–1.70), injecting opioids only (aOR = 1.79, 95% CI 1.35–2.38), and opioid/stimulant co-injection versus stimulant-only injection use (aOR = 1.46, CI 95%, 1.03–2.6). WWID also had higher odds of engaging in recent sexual activity (aOR = 1.75, 95% CI, 1.25–2.45), exchanging sex for money/resources (aOR = 6.60, 95% CI, 4.12–10.57), and testing reactive for HCV antibody at time of enrollment (aOR = 1.41, 95% CI, 1.10–1.80). Conclusion Drawing on real-world programmatic data from routine SSP intake, this study highlights the. elevated injection and sexual health risks faced by WWID accessing a SSP. Findings support the need for gender-responsive harm reduction strategies, including bundled, trauma-informed services that integrate safer injection supplies, overdose prevention, reproductive and sexual healthcare, and peer-led education initiatives that also address the social and structural determinants of health—such as trauma, poverty, housing instability, stigma, criminalization, and relational dynamics. These findings directly informed the development of a women-centered harm reduction clinic at the IDEA Miami SSP. This model may inform responsive service design in similar settings.