Overlapping Adverse Health Outcomes Among People who Inject Drugs in England, Wales and Northern Ireland, 2019-2020

Author: Claire Edmundson Sara Croxford Eva Emanuel Jacquelyn Njoroge Lucinda Slater Vivian Hope Monica Desai

Theme: Epidemiology & Public Health Research Year: 2022

People who inject drugs (PWID) have increased risk of a wide range of negative health outcomes.
We describe the burden and overlap of infections and overdose among PWID, alongside associated
risk behaviours, to better understand their impact.
We analysed data from the Unlinked Anonymous Monitoring Survey in England, Wales and Northern
Ireland (EWNI). Participants self-completed a questionnaire and provided a biological sample tested
for HIV, HBV and HCV. We included data for 2019/20 (first participations) from those who injected
during the preceding year. We assessed prevalence of HIV, current HCV and HBV, overdose and/or a
skin and soft tissue infection (SSTI) in the preceding year. PWID were grouped by the number of
adverse health outcomes and behaviours compared through multivariable logistic regression,
adjusting for age, gender and region, using Stata-15.
During 2019/20, 0.7% were HIV positive, 27% had chronic HCV and 0.3% current HBV; 38% reported
a SSTI and 22% an overdose during the preceding year. Overall, 18% had ≥2 adverse health
outcomes. Compared to PWID with ≤1 , those with ≥2 adverse outcomes had significantly greater
odds of reporting high-risk behaviours: sharing injecting equipment (adjusted odds ratio: 1.65; 95%
confidence interval: 1.28-2.14), stimulant (1.69; 1.26-2.27) or neck injection (2.16; 1.36-3.41) in the
preceding month, ever imprisonment (1.37; 1.05-1.79), ever homelessness (1.68; 1.19-2.38), and
multiple sexual partners in the preceding year (1.42; 1.08-1.86). Those with ≥2 adverse outcomes
had lower odds of reporting current drug treatment engagement (0.70; 0.54-0.91) but higher odds
for needle and syringe programme (NSP) use during the preceding year (1.69; 1.15-2.47).
A significant group of PWID in EWNI experience overlapping adverse health outcomes. Despite high
engagement with NSP, people with overlapping adverse health outcomes are more likely to exhibit
high-risk behaviours. Provision of holistic services is required to meet the multiple complex needs of
this population.
Disclosure of Interest Statement:
No conflicts of interest.

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