Table 1.

Components and definitions of the composite harm mitigation score¹

Score component	Applicable group (denominator)	Scores and category definitions
Service access
HIV care continuum	HIV-positive	0 – Suppressed viral load (HIV RNA <200 c/mL) 1 – Not suppressed and either i) took antiretroviral therapy in prior 30 days or ii) had visit with HIV provider in prior 6 months 2 – Not suppressed and did not take antiretroviral therapy in prior 30 days and did not have visit with HIV provider in prior 6 months
HIV testing	HIV-negative	0 – Had HIV test in past 6 months 1 – Did not have HIV test in past 6 months
PrEP use	HIV-negative	0 – Used PrEP in prior 6 months 1 – Did not use PrEP in prior 6 months
HCV care continuum	HCV-positive i. Detectable HCV RNA or ii. HCV seropositive, undetectable HCV RNA, and history of HCV treatment	0 – Prior HCV treatment and undetectable HCV RNA (<15 IU/L) 1 – Detectable HCV RNA and either treated for HCV or evaluated by HCV provider in prior 6 months 2 – Detectable HCV RNA and not treated for HCV or evaluated by HCV provider in prior 6 months.
HCV testing	HCV-negative i. HCV seronegative or ii. HCV seropositive, undetectable HCV RNA, and no history of HCV treatment	0 – Had HCV test in past 6 months 1 – Did not have HCV test in past 6 months
MOUD use	All	0 – Used MOUD in past 6 months 1 – Did not use MOUD in past 6 months
NEP use	Injected in prior 6 months	0 – Used NEP in past 6 months 1 – Did not use NEP in past 6 months
Available naloxone kit	All	0 – Has naloxone kit on person or where drugs used 1 – Does not have accessible naloxone kit
Risk behaviors
Injection drug use	All	0 – No injection drug use in prior 6 months 1 – Injection drug use in prior 6 months
Recent drug use	All	0 – Urine drug test negative for drugs2 1 – Urine drug test positive for one or more drugs2
Sharing injecting equipment	All	0 – No sharing syringe/works or not injecting in prior 6 months 1 – Sharing works (cotton/cooker) only in prior 6 months 2 – Sharing needle/syringe in prior 6 months
Adverse outcomes
Non-fatal overdose	All	0 – No overdose in prior 6 months 1 – One or more overdose in prior 6 months
Emergency department use	All	0 – No emergency department visits in past 6 months 1 - One or more emergency department visits in past 6 months
Clinical status change (assessed at follow-up only)
HIV seroconversion	HIV-negative	0 – No HIV seroconversion 2 - HIV seroconversion occurring between baseline and follow-up
HCV seroconversion	HCV-negative	0 – No HCV seroconversion 1 - HCV seroconversion occurring between baseline and follow-up
Death	All	0 – Alive Maximum points – Death confirmed by National Death Index

PWID, people who inject drugs; HCV, hepatitis C virus; PrEP, pre-exposure prophylaxis; MOUD, medication for opioid use disorder; NEP, needle exchange program.

¹Score ranges from 0 to 13 or 15 (depending on HIV and HCV status) with higher scores indicating worse status.

²Includes fentanyl (or metabolite), heroin (morphine or 6-monoacetylmorphine), cocaine (or metabolite), amphetamine, or methamphetamine.