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Rural areas of the United States may be vulnerable to an HIV or hepatitis C (HCV) outbreak among persons who inject drugs. We conducted semi-structured interviews with 36 state and local public health professionals from six rural states to gain an understanding of the challenges rural communities face and strategies they are using to prepare for, identify, and respond to HIV and/or HCV outbreaks due to intravenous drug use. Key informants described inadequate funding, insufficient staffing, limited health care infrastructure, and other factors as limiting the public health capacity of rural areas. Promising prevention, surveillance, and treatment strategies in rural areas included the use of mobile treatment units, telemedicine approaches, and community education initiatives to overcome resistance to evidence-based harm reduction programs.

Voices from the Field: A Qualitative Study of the Challenges and Promising Practices of Rural Public Health in Addressing HIV and Hepatitis C