COVID-19 - Enacting a ‘new normal’ for people who use drugs

Chang, Judy; Agliata, Jake; Guarinieri, Mauro

doi:10.1016/j.drugpo.2020.102832

Cited by 57 publications

(58 citation statements)

References 15 publications

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“…Pandemics expose weaknesses in societies and bring to the fore a country’s ability to respond and protect its most vulnerable people [ 22 ]. Measures to mitigate the effects of COVID-19 have had serious social and economic impacts; although they have affected everyone, the impact is largest among marginalised and vulnerable populations [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

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The impact of the COVID-19 pandemic on harm reduction services in Spain

Picchio

Valencia²,

Doran

et al. 2020

Harm Reduct J

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Background Containment policies and other restrictions introduced by the Spanish government in response to the COVID-19 pandemic present challenges for marginalised populations, such as people who use drugs. Harm reduction centres are often linked to social services, mental health services, and infectious disease testing, in addition to tools and services that help to reduce the harms associated with injecting drugs. This study aimed to explore the impact of the pandemic on these services in four autonomous communities in Spain. Methods This is a cross-sectional study that employed a seven-section structured survey administered electronically to 20 centres in July 2020. Data from the most heavily affected months (March–June) in 2020 were compared to data from the same period in 2019. Averages were calculated with their ranges, rates, and absolute numbers. Results All 11 responding centres reported having had to adapt or modify their services during the Spanish state of alarm (14 March–21 June 2020). One centre reported complete closure for 2 months and four reported increases in their operating hours. The average number of service users across all centres decreased by 22% in comparison to the same period in the previous year and the average needle distribution decreased by 40% in comparison to 2019. Most centres reported a decrease in infectious disease testing rates (hepatitis B and C viruses, human immunodeficiency virus, and tuberculosis) for March, April, and May in 2020 compared to the previous year. Reported deaths as a result of overdose did not increase during the state of alarm, but 2/11 (18%) centres reported an increase in overdose deaths immediately after finalisation of the state of alarm. Conclusion Overall, Spanish harm reduction centres were able to continue operating and offering services by adjusting operating hours. The number of overall service users and needles distributed fell during the Spanish state of alarm lockdown period, suggesting that fewer clients accessed harm reduction services during this time, putting them at greater risk of reusing or sharing injecting equipment, overdosing, acquiring infectious diseases with decreased access to testing or discontinuing ongoing treatment such as methadone maintenance therapy, hepatitis C treatment, or antiretroviral therapy.

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Section: Discussionmentioning

confidence: 99%

“…Service closures and disruptions have been reported in the United States, western and eastern Europe, sub-Saharan Africa, and Latin America and the Caribbean [ 22 , 25 – 28 ]. Our study found that all of the 13 participating harm reduction centres reported having had to modify or adapt their services.…”

Section: Discussionmentioning

confidence: 99%

The impact of the COVID-19 pandemic on harm reduction services in Spain

Picchio

Valencia²,

Doran

et al. 2020

Harm Reduct J

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“…Pandemics expose weaknesses in societies and bring to the fore a country's ability to respond and protect its most vulnerable people (22) responded) actually increased their operating hours during this period. Although Spain was one of the most heavily affected countries in the European Union, its network of harm reduction centres showed resilience by adapting policy changes and innovative strategies to deliver essential services to PWUD.…”

Section: Discussionmentioning

confidence: 99%

The impact of the COVID-19 pandemic on harm reduction services in Spain

Picchio

Valencia²,

Doran

et al. 2020

Preprint

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Background: Containment policies and other restrictions introduced by the Spanish government in response to the COVID-19 pandemic present challenges for marginalised populations, such as people who use drugs. Harm reduction centres are often linked to social services, mental health services, and infectious disease testing, in addition to tools and services that help to reduce the harms associated with injecting drugs. This study aimed to explore the impact of the pandemic on these services in four autonomous communities in Spain.Methods: This is a cross-sectional study that employed a seven-section structured survey administered electronically to 20 centres in July 2020. Data from the most heavily affected months (March–June) in 2020 were compared to data from the same period in 2019. Averages were calculated with their ranges, rates, and absolute numbers.Results: All 11 responding centres reported having had to adapt or modify their services during the Spanish state of alarm (14 March–21 June 2020). One centre reported complete closure for two months and four reported increases in their operating hours. The average number of service users across all centres decreased by 22% in comparison to the same period in the previous year and the average needle distribution decreased by 40% in comparison to 2019. Most centres reported a decrease in infectious disease testing rates (hepatitis B and C viruses [HBV, HCV], human immunodeficiency virus (HIV), and tuberculosis [TB]) for March, April, and May in 2020 compared to the previous year. Reported deaths as a result of overdose did not increase during the state of alarm, but 2/11 (18%) centres reported an increase in overdose deaths immediately after finalisation of the state of alarm.Conclusion: Overall, like other European countries, Spanish harm reduction centres were able to continue operating and offering services by adjusting operating hours. The number of overall service users and needles distributed fell during the Spanish state of alarm lockdown period, suggesting that fewer clients accessed harm reduction services during this time, putting them at greater risk of reusing or sharing injecting equipment, overdosing, acquiring infectious diseases with decreased access to testing or discontinuing ongoing treatment (methadone maintenance therapy, hepatitis C treatment, or antiretroviral therapy).

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“…6 However, if hospitals and clinics reach their capacity, disadvantaged populations such as PWID may experience even greater barriers to medical care for COVID-19. 15 Self-quarantine, physical distancing and other public health measures, the economic repercussions of the epidemic, and mental distress have disrupted access to syringe services programs, access to pharmacotherapies including medication for opioid use disorder (MOUD), and other support needed by people with opioid use disorder (OUD), 16 potentially putting this already disproportionately affected population at higher risk for HIV infection and drug overdose mortality. Likewise, disruptions in social services such as housing, food, and social counselling could complicate risk behaviour management and medical care provision for all PLHIV.…”

Section: Introductionmentioning

confidence: 99%

The Potential Epidemiological Impact of Coronavirus Disease 2019 (COVID-19) on the Human Immunodeficiency Virus (HIV) Epidemic and the Cost-effectiveness of Linked, Opt-out HIV Testing: A Modeling Study in 6 US Cities

Zang

Krebs

Chen

et al. 2020

Clinical Infectious Diseases

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Background Widespread viral and serological testing for SARS-CoV-2 may present a unique opportunity to also test for HIV infection. We estimated the potential impact of adding linked, opt-out HIV testing alongside SARS-CoV-2 testing on HIV incidence and the cost-effectiveness of this strategy in six US cities. Methods Using a previously-calibrated dynamic HIV transmission model, we constructed three sets of scenarios for each city: (1) sustained current levels of HIV-related treatment and prevention services (status quo); (2) temporary disruptions in health services and changes in sexual and injection risk behaviours at discrete levels between 0%-50%; and (3) linked HIV and SARS-CoV-2 testing offered to 10%-90% of the adult population in addition to scenario (2). We estimated cumulative HIV infections between 2020-2025 and incremental cost-effectiveness ratios of linked HIV testing over 20 years. Results In the absence of linked, opt-out HIV testing, we estimated a total of 16.5% decrease in HIV infections between 2020-2025 in the best-case scenario (50% reduction in risk behaviours and no service disruptions), and 9.0% increase in the worst-case scenario (no behavioural change and 50% reduction in service access). We estimated that HIV testing (offered at 10%-90% levels) could avert a total of 576-7,225 (1.6%-17.2%) new infections. The intervention would require an initial investment of $20.6M-$220.7M across cities; however, the intervention would ultimately result in savings in health care costs in each city. Conclusions A campaign in which HIV testing is linked with SARS-CoV-2 testing could substantially reduce HIV incidence and reduce direct and indirect health care costs attributable to HIV.

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COVID-19 - Enacting a ‘new normal’ for people who use drugs

Cited by 57 publications

References 15 publications

The impact of the COVID-19 pandemic on harm reduction services in Spain

The impact of the COVID-19 pandemic on harm reduction services in Spain

The impact of the COVID-19 pandemic on harm reduction services in Spain

The Potential Epidemiological Impact of Coronavirus Disease 2019 (COVID-19) on the Human Immunodeficiency Virus (HIV) Epidemic and the Cost-effectiveness of Linked, Opt-out HIV Testing: A Modeling Study in 6 US Cities

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