This study, conducted by collaborators from CDC and other Public Health agencies, examines a recent IDU-associated HIV outbreak in West Virginia. Health records and state surveillance data were reviewed for 65 PWID residing in Kanawha County who received an HIV diagnosis between January 1, 2019 and June 18, 2021 – specifically, investigators analyzed health care encounter and HIV- and opioid-related service data from 1 year before HIV diagnosis through June 18, 2021. Median age at HIV diagnosis was 34 years; 54% of PWID were male, 62% ever experienced homelessness/unstable housing, 35% were ever diagnosed with a mental health condition, and 31% were previously incarcerated. Medical record documentation indicated illicit opioid use for 85% and methamphetamine use for 85%; overall, polysubstance use was documented for 88%. 18% were ever classified as having stage 3 AIDS and 30% were engaged in HIV care within the last 3 months (34% were ever virally suppressed). Of 496 encounters occurring over 127 person-years of follow-up, 42% occurred in the emergency department, 20% were inpatient, and 38% occurred in ambulatory settings. Among 291 opioid-related encounters, prescriptions for naloxone and medications for OUD were documented in 10% and 20% of encounters, respectively. No one was prescribed HIV pre-exposure prophylaxis.