Case study: accessible primary health care--a foundation to improve health outcomes for people who inject drugs.

Injecting drug users (IDUs) represent a large part of the population with HIV globally, however, IDUs continue to have less access to HIV treatment than non-IDUs. While IDUs with HIV potentially fare as well on anti-retroviral therapy (ART) as non-IDUs in terms of HIV disease progression, ART adherence is critical. Opioid dependent IDUs may experience lifestyle instability affecting ART adherence. IDUs often have a range of complex health and social welfare needs beyond HIV. Opioid agonist pharmacotherapies such as methadone maintenance treatment, improve overall health and psychosocial stability among opioid-dependent IDUs. The integration of pharmacotherapies into primary health care settings also allows the direct observation of the concomitant administration of HIV treatments. This dual treatment approach maximises HIV treatment adherence and enables the timely management of other clinical issues. Where relevant, sexual and reproductive, infant and maternal health services should also be incorporated alongside HIV and hepatitis B and C prevention services. Services should be anonymous and confidential, and be provided by a multidisciplinary team in a non-judgemental way. Involvement of IDUs in service planning should also be promoted to ensure the acceptability of the model to the target population. The Kirketon Road Centre (KRC) in Kings Cross, Australia, is an example of a community-based primary health care service delivery model that comprehensively addresses a range of complex health and social welfare needs IDUs may have. Established in 1987 to prevent HIV/AIDS and other transmissible infections among "at risk" young people, IDUs and commercial sex workers, the KRC model has also proven versatile in upscaling to meet hepatitis C and other emerging health needs of IDUs in a timely way. Integrated primary health care models should be promoted more widely as a foundation to improve the health outcomes of IDUs.