COVID-19 vaccination and HIV transmission among persons who inject drugs during the first two years of the COVID-19 pandemic in New York City

Abstract

Background To examine COVID-19 vaccination and HIV transmission among persons who inject drugs (PWID) during the COVID-19 pandemic (2020–2022) in New York City (NYC). Methods Two hundred and seventy five PWID were recruited from October 2021 to September 2022. A structured questionnaire was used to measure demographics, drug use behaviors, overdose experiences, substance use treatment history, COVID-19 infection, vaccination, and attitudes. Serum samples were collected for HIV, HCV, and SARS-CoV-2 (COVID-19) antibody testing. Results Participants were: 71% male, the mean age was 49 (SD 11), 81% reported at least one COVID-19 immunization, 76% were fully vaccinated and 64% of the unvaccinated had antibodies for COVID-19. Self-reported injection risk behaviors were very low. HIV seroprevalence was 7%. Eighty-nine percent of the HIV seropositive respondents reported knowing they were HIV seropositive and being on antiretroviral therapy prior to the COVID-19 pandemic. There were two likely seroconversions in 518.83 person-years at risk from the March 2020 start of the pandemic to the times of interviews, for an estimated incidence rate of 0.39/100 person-years, 95% Poisson CI 0.05–1.39/100 person-years. Conclusions There is concern that the COVID-19 pandemic disruptions to HIV prevention services and the psychological stress of the pandemic may lead to increased risk behavior and increased HIV transmission. These data indicate adaptive/resilient behaviors in both obtaining COVID-19 vaccination and maintaining a low rate of HIV transmission among this sample of PWID during the first two years of the COVID-19 pandemic in NYC.

Prevalence and correlates of SARS-CoV-2 seropositivity among people who inject drugs in Baltimore, Maryland

“…The finding that anti-S antibody prevalence was significantly lower among younger participants and marginally lower in female participants is consistent with our prior work in this cohort that found younger and female participants were less likely to be vaccinated against COVID-19 during March to June 2021 ( Cepeda et al., 2022 ). The association of age and sex with the probability of COVID-19 vaccine uptake has varied in other samples of PWID ( Des Jarlais et al., 2023 ; Harvey-Vera et al., 2022 ; Iversen et al., 2022 ; Strathdee et al., 2023a ). Notably, in our cohort, we also previously found that younger and female participants were also more likely to express high levels of COVID-19 vaccine hesitancy ( Cepeda et al., 2022 ).…”

“…Notably, in our cohort, we also previously found that younger and female participants were also more likely to express high levels of COVID-19 vaccine hesitancy ( Cepeda et al., 2022 ). Even in New York City where there were many efforts to improve COVID-19 vaccination coverage among vulnerable populations which facilitated high vaccine uptake among PWID (81%), the strongest predictor of remaining unvaccinated was having negative attitudes about the vaccine ( Des Jarlais et al., 2023 ). PWID who remain unvaccinated may be misinformed about the COVID-19 vaccine, have institutional and/or medical distrust, and/or a low perceived risk of COVID-19 ( Aronson et al., 2022 ; Valasek et al., 2022 ).…”

“…Given that the spread of SARS-CoV-2 has been heterogeneous by population, geography, and time throughout the pandemic, these findings on infection risk may not be generalizable or transportable to other populations, settings, or points in time ( Rudolph et al., 2023 ). Previous studies have highlighted disparities in COVID-19 vaccine uptake based on self-reported and medical record data among current and former PWID ( Cepeda et al., 2022 ; Des Jarlais et al., 2023 ; Iversen et al., 2022 ; Strathdee et al., 2023a ); however, there remains limited data characterizing the distribution of infection and/or vaccination-induced anti-S antibodies among PWID following widespread SARS-CoV-2 infection and vaccination.…”

COVID-19 vaccination uptake and determinants of booster vaccination among persons who inject drugs in New York City

“…Lower scores on the scale indicated positive attitudes toward vaccination or alignment with evidence-based public health strategies for addressing the COVID-19 pandemic, commonly referred to as pro-vaccine. The scale demonstrated a high level of reliability, with a Cronbach’s α value of 0.81 [ 17 , 19 ].…”

“…For example, 38% of PWID in San Diego [ 2 ], 68% in Baltimore [ 14 ], 49% in Australia [ 15 ], and 40% in Tijuana Mexico [ 16 ] reported having at least one COVID-19 vaccine dose. We also previously estimated that 81% of PWID in NYC received at least one COVID-19 vaccine, and 76% were fully vaccinated [ 17 ].However, despite the high rate of comorbidities and the increased risk of severe illness and mortality from COVID-19 among PWID, as well as the importance of receiving booster vaccination, studies exploring the uptake of COVID-19 booster vaccines and its associated factors in this population remain limited after the widespread availability of booster vaccines in the US. We aimed to examine COVID-19 vaccine uptake and factors associated with booster vaccination among PWID in NYC.…”