Impact of the Coronavirus Disease 2019 Pandemic on Substance Use Disorder Risk Among People Living With Human Immunodeficiency Virus (HIV) Enrolled in HIV Care in the United States: An Interrupted Time Series Analysis

Jennifer P Jain; Megan J Heise; Nadra E Lisha; Carlos H Moreira; David V Glidden; Greer A Burkholder; Heidi M Crane; Jeffrey M Jacobson; Edward R Cachay; Kenneth H Mayer; Sonia Napravnik; Richard D Moore; Carol Dawson-Rose; Mallory O Johnson; Katerina A Christopoulos; Monica Gandhi; Matthew A Spinelli

doi:10.1093/ofid/ofae491

Impact of the Coronavirus Disease 2019 Pandemic on Substance Use Disorder Risk Among People Living With Human Immunodeficiency Virus (HIV) Enrolled in HIV Care in the United States: An Interrupted Time Series Analysis

Open Forum Infect Dis. 2024 Aug 26;11(9):ofae491. doi: 10.1093/ofid/ofae491. eCollection 2024 Sep.

Authors

Jennifer P Jain¹, Megan J Heise², Nadra E Lisha³, Carlos H Moreira², David V Glidden³, Greer A Burkholder⁴, Heidi M Crane⁵, Jeffrey M Jacobson⁶, Edward R Cachay⁷, Kenneth H Mayer⁸, Sonia Napravnik⁹, Richard D Moore¹⁰, Carol Dawson-Rose¹¹, Mallory O Johnson¹, Katerina A Christopoulos², Monica Gandhi², Matthew A Spinelli²

Affiliations

¹ Division of Prevention Science, University of California, San Francisco, California, USA.
² Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA.
³ Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.
⁴ Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA.
⁵ Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA.
⁶ Divsion of Infectious Diseases, Case Western Reserve University, Cleveland, Ohio, USA.
⁷ Division of Infectious Diseases, University of California, San Diego, California, USA.
⁸ Department of Medicine, Harvard University, Boston, Massachusetts, USA.
⁹ Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA.
¹⁰ Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA.
¹¹ School of Nursing, University of California, San Francisco, California, USA.

Abstract

Background: Rising overdose deaths globally and increased social isolation during the coronavirus disease 2019 (COVID-19) pandemic may have disproportionately impacted people with human immunodeficiency virus (PWH) with substance use disorders (SUD). We examined trends in SUD risk among PWH before and after the COVID-19 shelter-in-place (SIP) mandate.

Methods: Data were collected between 2018 and 2022 among PWH enrolled across 8 US sites in the Centers for AIDS Research Network of Integrated Clinical Systems cohort. We evaluated changes in moderate/high SUD risk after SIP using interrupted time series analyses.

Results: There were 7126 participants, including 21 741 SUD assessments. The median age was 51 (interquartile range, 39-58) years; 12% identified as Hispanic or Latino/Latina, 46% Black/African American, and 46% White. Moderate/high SUD risk increased continuously after the pandemic's onset, with 43% (95% confidence interval [CI], 40%-46%) endorsing moderate/high SUD risk post-SIP, compared to 24% (95% CI, 22%-26%) pre-SIP (P < .001). There were increases in the use of heroin, methamphetamine, and fentanyl, and decreases in prescription opioids and sedatives post-SIP. Further, there was a decrease in reported substance use treatment post-SIP compared to pre-SIP (P = .025).

Conclusions: The rising prevalence of SUD through late 2022 could be related to an increase in isolation and reduced access to substance use and HIV treatment caused by disruptions due to COVID-19. A renewed investment in integrated substance use treatment is vital to address the combined epidemics of substance use and HIV following the COVID-19 pandemic and to support resilience in the face of future disruptions.

Keywords: COVID-19; HIV/AIDS; LGBTQ; depression symptoms; substance use disorder.

Abstract

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