Background:
The COVID-19 pandemic disrupted healthcare and social support and may have disproportionately affected vulnerable people, such as those living with HIV and hepatitis C (HCV). We investigate how drug use changed in CCC participants, while also considering HCV RNA status, over this period.
Methods:
We selected participants enrolled prior to March 2018 with at least one subsequent follow up visit. Participants were classified as i) active PWID if they reported injection drug use (IDU) at their last visit prior to March 2018 and ii) having active HCV infection (HCV RNA positive) at this last visit. We then modelled the probability of injection and non-injection drug (NDU) use from 2018 to 2024 using a generalised additive model, with covariate adjustment for age. The model included a random intercept allowing for repeated observations from the same individuals.
Results:
Among 329 active PWID, the median age was 49; 33% were female and 40% were Indigenous. The median duration of HIV infection was 15 years; 47% were HCV RNA positive.
The probability of reporting IDU declined during the period, particularly during the pandemic period (2020-2022) (Figure 1) whereas the probability of reporting NDU gradually increased throughout this period. For those with active HCV prior to March 2018, IDU declined during the pandemic, with rebound in the post-pandemic period accompanied by a decrease in reported NDU.
Conclusion:
In PWID who previously cured (or cleared) their HCV infection, reported IDU declined over the six year period while NDU increased, suggesting they adapted routes of drug taking with lower risk for re-infection. While a similar decline in IDU was seen among PWID with active HCV during the pandemic, there appears to be a post-pandemic return to using injection drugs which could have implications for eliminating HCV. Harm reduction strategies should evolve to include NDU supports. |