PURPOSE: An increase in injection drug use (IDU) has placed new populations at risk for HIV. Understanding the spatial and temporal patterns of HIV diagnoses and care outcomes is crucial to identify gaps in care for people who inject drugs (PWID). METHODS: We analyzed CDC's National HIV Surveillance System (NHSS) data from 2016 to 2022 to examine regional trends and rural-urban differences in linkage to HIV care within one month and viral suppression within six months of diagnosis among individuals aged 13 and older with HIV attributed to IDU. Rural-urban populations were defined using US Department of Agriculture-Economic Research Service (USDA-ERS) Rural-Urban Continuum Codes (RUCC), and trends were assessed using estimated annual percentage change (EAPC). RESULTS: From 2016 to 2022, HIV diagnoses attributed to IDU increased in large rural counties and small to medium urban counties but linkage to care and viral suppression remained unchanged in these areas. Conversely, diagnoses in large urban counties declined while linkage to care and viral suppression increased. CONCLUSIONS: These findings highlight disparities in HIV diagnoses, linkage to care, and viral suppression across rural and urban areas, emphasizing the need to address these gaps to improve care for PWID and inform public health policies.