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People who inject drugs (PWID) experience a high incidence of abscesses and chronic wounds. However, many PWID delay seeking care for their wounds. In 2012, the Baltimore Needle Exchange Program (BNEP) in Baltimore, Maryland, partnered with the Johns Hopkins Wound Healing Center to establish a mobile BNEP Wound Clinic. This clinic provided specialized wound care for BNEP patients. In sixteen months, the clinic treated 78 unique patients during 172 visits overall. On average, each visit cost the program $146.45, which was substantially less than clinic-based treatment. This program demonstrates that specialized wound care can be effectively provided through mobile outreach. A community-based service delivery approach might serve as a model for local health departments looking to improve the health of PWID. (Am J Public Health. 2014;104:2057-2059. doi:10.2105/AJPH.2014.302111)
INJECTION-RELATED WOUNDS, including abscesses and chronic ulcers, are major causes of morbidity for people who inject drugs (PWID).1 Previous stud- ies describe wound prevalence in the PWID population to be between 29% and 36%2 and prevalence of injection-related skin infection history to be between 55% and 68%.3,4 Left untreated, injection-related wounds may lead to more severe complications such as sepsis, gangrene, or endocar- ditis.1 Additionally, chronic wounds are costly to the health care system. Venous leg ulcers, a common cause of chronic wounds among PWID, have an average monthly treatment cost of $4095.5
Compared with non-drug- using populations, PWID have disproportionately high rates of emergency department utiliza- tion and are less likely to receive care for their medical conditions.6 Health clinics using harm-reduc- tion models appear cost-effective and can improve health outcomes by minimizing barriers to care.7,8 Additionally, syringe exchange programs often refer PWID to a variety of heath services.8
The Baltimore, Maryland, met- ropolitan area has an estimated 40 000 PWID.9 Since 1994, the Baltimore City Health Depart- ment has operated the Baltimore Needle Exchange Program (BNEP) out of converted rec- reational vehicles (RVs). BNEP travels to fixed sites across the city and provides clean needles and injection tools to PWID. BNEP also offers overdose pre- vention training, immunizations, and reproductive health services. These programs have been shown to have lower costs and be successful in providing care to marginalized populations.10,11
BACKGROUND AND PROGRAM DESIGN
Since the BNEP's incep- tion, staff reported high rates of abscesses...