The Hidden Epidemic: Epidemiology of Acute Infections in People Who Inject Drugs in Fiji

Injection drug use is an emerging challenge in Fiji and the Pacific region, where injection-related infections may contribute substantially to morbidity, mortality and healthcare burden. However, data on the epidemiology and outcomes of these infections remain limited.

We conducted an observational cross-sectional study among people who inject drugs admitted to hospital with infections over a 6-month period. Data on infection type, injecting practices, substance use history, and relevant clinical and demographic variables were collected using a structured questionnaire and medical record review.

Of the 128 participants, 76% were males. The majority were of iTaukei ethnicity (95%). Most were in the 18-25-year-old age range. The predominant infection was HIV (n = 97, 76%) and 42 (33%) patients had a positive blood culture. Staphylococcus aureus was the most common bacterial pathogen identified. Median length of stay was 10 days (interquartile range 6-14 days) with 31% in-hospital mortality.

This study highlights the high burden of acute infections and associated morbidity and mortality among people who inject drugs in Fiji, compounded by social vulnerabilities and limited access to harm reduction services. The findings underscore the urgent need for integrated patient-centred interventions, including hospital management, community harm reduction and strengthened surveillance to improve health outcomes in this population.