A stakeholder-driven framework for measuring potential change in the health risks of people who inject drugs (PWID) during the COVID-19 pandemic

Heather Bradley; Chelsea Austin; Sean T Allen; Alice Asher; Tyler S Bartholomew; Amy Board; Annick Borquez; Kate Buchacz; Anastasia Carter; Hannah L F Cooper; Judith Feinberg; Nathan Furukawa; Becky Genberg; Pamina M Gorbach; Holly Hagan; Emalie Huriaux; Hermione Hurley; Nicole Luisi; Natasha K Martin; Eli S Rosenberg; Steffanie A Strathdee; Don C Des Jarlais

doi:10.1016/j.drugpo.2022.103889

A stakeholder-driven framework for measuring potential change in the health risks of people who inject drugs (PWID) during the COVID-19 pandemic

Int J Drug Policy. 2022 Dec:110:103889. doi: 10.1016/j.drugpo.2022.103889. Epub 2022 Oct 17.

Authors

Heather Bradley¹, Chelsea Austin², Sean T Allen³, Alice Asher⁴, Tyler S Bartholomew⁵, Amy Board⁴, Annick Borquez⁶, Kate Buchacz⁴, Anastasia Carter², Hannah L F Cooper⁷, Judith Feinberg⁸, Nathan Furukawa⁴, Becky Genberg³, Pamina M Gorbach⁹, Holly Hagan¹⁰, Emalie Huriaux¹¹, Hermione Hurley¹², Nicole Luisi⁷, Natasha K Martin⁶, Eli S Rosenberg¹³, Steffanie A Strathdee⁶, Don C Des Jarlais¹⁰

Affiliations

¹ Georgia State University School of Public Health, 140 Decatur Street SE, Atlanta, GA, 30303, USA. Electronic address: hbradl2@emory.edu.
² Georgia State University School of Public Health, 140 Decatur Street SE, Atlanta, GA, 30303, USA.
³ Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
⁴ Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30333, USA.
⁵ University of Miami Miller School of Medicine, 1600 NW 10(th) Avenue, #1140, Miami, FL, 33136, USA.
⁶ University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
⁷ Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA, 30322, USA.
⁸ West Virginia University Health Sciences, 1 Medical Center Drive, #1000, Morgantown, WV, 26506, USA.
⁹ University of California Los Angeles, Fielding School of Public Health.
¹⁰ NYU School of Global Public Health, 708 Broadway, New York, NY, 10003, USA.
¹¹ Washington State Department of Health, 101 Israel Road SE, Tumwater, WA, 98501, USA.
¹² Denver Health, 777 Bannock Street, Denver, CO, 80204, USA.
¹³ University at Albany School of Public Health, SUNY, 1 University Place, Rensselaer, NY, 12144, USA; Office of Public Health, New York State Department of Public Health, Corning Tower, State Street, Albany, NY, 12203, USA.

Abstract

Background: People who inject drugs (PWID) have likely borne disproportionate health consequences of the COVID-19 pandemic. PWID experienced both interruptions and changes to drug supply and delivery modes of harm reduction, treatment, and other medical services, leading to potentially increased risks for HIV, hepatitis C virus (HCV), and overdose. Given surveillance and research disruptions, proximal, indirect indicators of infectious diseases and overdose should be developed for timely measurement of health effects of the pandemic on PWID.

Methods: We used group concept mapping and a systems thinking approach to produce an expert stakeholder-generated, multi-level framework for monitoring changes in PWID health outcomes potentially attributable to COVID-19 in the U.S. This socio-ecological measurement framework elucidates proximal and distal contributors to infectious disease and overdose outcomes, many of which can be measured using existing data sources.

Results: The framework includes multi-level components including policy considerations, drug supply/distribution systems, the service delivery landscape, network factors, and individual characteristics such as mental and general health status and service utilization. These components are generally mediated by substance use and sexual behavioral factors to cause changes in incidence of HIV, HCV, sexually transmitted infections, wound/skin infections, and overdose.

Conclusion: This measurement framework is intended to increase the quality and timeliness of research on the impacts of COVID-19 in the context of the current pandemic and future crises. Next steps include a ranking process to narrow the drivers of change in health risks to a concise set of indicators that adequately represent framework components, can be written as measurable indicators, and are quantifiable using existing data sources, as well as a publicly available web-based platform for summary data contributions.

Keywords: COVID-19; HIV; Hepatitis C; Overdose; People who inject drugs.

MeSH terms

COVID-19* / epidemiology
Drug Overdose* / epidemiology
Drug Users*
HIV Infections* / epidemiology
Hepacivirus
Hepatitis C* / epidemiology
Humans
Pandemics
Pharmaceutical Preparations
Substance Abuse, Intravenous* / complications
Substance Abuse, Intravenous* / epidemiology

Substances

Pharmaceutical Preparations