Infectious disease screening rates among people who use drugs in open drug scenes: a brief report

Background and objectives: People who use drugs (PWUD) face a high risk of infectious diseases, including tuberculosis (TB), HIV, hepatitis B (HBV), hepatitis C (HCV), and syphilis. Brazil has one of the world's largest crack-cocaine markets, with major cities struggling with public health challenges linked to open drug scenes (ODS), where illicit drugs are openly used and traded. However, epidemiological data on screening rates and infection prevalence within ODS in Brazil remains scarce. This study examines the self-reported prevalence of screening tests for TB, HIV, syphilis, HBV, and HCV, as well as the factors influencing screening rates. Methods: Three cross-sectional, self-report surveys of 900 PWUD in ODS in Sao Paulo between 2017 and 2022 were analysed. Results: The majority of participants (68.26%) were male, with a mean age of 36.89 years. More than half (57.28%) reported sleeping in ODS most or all days of the week, and 53.51% had been frequenting ODS for at least five years. Screening rates varied by disease, with the highest overall prevalence for HIV (63.59%) followed by TB(59.93%) and Syphilis (59.56%), HBV(50.22%) and HCV (48.94%). Across all infections, screening rates declined between 2017 and 2022. Factors associated with screening included age, gender, education, survey year, and ODS duration. Conclusion: These findings highlight gaps in screening coverage, emphasising the need for targeted interventions to improve care in ODS. We advocate for a national serial bio-behavioural survey of PWUD in ODS to accurately assess screening prevalence, infection rates, and risk factors, which remain unmonitored.