Health literacy and changes in pattern of drug use among participants at the Stockholm Needle Exchange Program during the COVID-19 pandemic

Abstract

Background and aims People who inject drugs may be particularly vulnerable to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to underlying health problems, stigma and social vulnerabilities. Harm reduction services, including needle exchange programs (NEP), have been subjected to varying degrees of disruption in the world, especially in the beginning of the coronavirus disease 2019 (COVID-19) pandemic. Compared to responses in other countries, Sweden’s initial strategy toward limiting the spread and impact of COVID-19 was less restrictive to its citizens with no imposed general societal lockdown. In this study, we investigate changes in drug use patterns, utilization of NEP associated health services, COVID-19 health literacy and the prevalence of SARS-CoV-2 antibodies among NEP clients in Stockholm during the COVID-19 pandemic. Methods NEP visits and services provided (needles/syringes, HIV and hepatitis C tests and treatment, naloxone distributed) and overall mortality among NEP clients between January 1 and October 31, 2020, were used for trend analyses in comparison with corresponding 2019 data. Between July 27 and October 2, 2020, NEP clients (n = 232) responded to a 27 item COVID-19 Health Literacy Questionnaire. SARS CoV-2 IgG antibody tests (n = 779) were performed between June 15 and October 31, 2020. Results During the COVID-19 pandemic number of clients, client visits, naloxone distribution and HCV tests remained stable compared to 2019, while distribution of needles/syringes increased (p < 0.0001); number of HIV tests and HCV treatments decreased (p < 0.05); and mortality decreased (< 0.01). Overall, the level of health literacy concerning transmission routes and protective measures was high. SARS-CoV-2 antibody prevalence was 5.4% (95% CI 4.0–7.2). Conclusions The Stockholm NEP managed to maintain a high level of clients and services during the pandemic. In general, COVID-19 health literacy was adequate and the overall SARS-CoV-2 antibody prevalence was low compared to the general population, which highlights a need for prioritized and targeted COVID-19 vaccination among PWID.

Prevalence and correlates of SARS-CoV-2 seropositivity among people who inject drugs in the San Diego-Tijuana border region

“…Reports in the literature of SARS-CoV-2 prevalence among people who inject drugs are sparse. In a study of needle exchange clients in Stockholm, Sweden, SARS-CoV-2 prevalence was 5.4% [ 12 ], whereas in a survey of people who inject drugs in England, Wales and Northern Ireland, 11% reported that they had tested positive for COVID-19 [ 13 ]. U.S. estimates among people who are homeless or living in shelters range from 2%-14% [ 14 – 16 ].…”

Understanding the Impacts of Novel Coronavirus Outbreaks on People Who Use Drugs: A Systematic Review to Inform Practice and Drug Policy Responses to COVID-19

“…Several studies reported reduced access to harm reduction services owing to the pandemic [48,52,61] though only one study inferred that this was related to a subsequent rise in DRDs [41]. More recent research has provided further evidence of the impacts of reduced service access including reductions in uptake of injecting equipment and MAT as well as a reduction of uptake of HIV and other BBV testing in Spain, UK and Sweden [75][76][77]. However, one recent study conducted in Sweden [76], which unlike many other countries did not impose a general societal lockdown, reported that harm reduction services were accessed as usual (at worst) during the initial stages of the pandemic and that distribution of needles and syringes increased.…”

Health worker perceptions of the impact of COVID‐19 on harm reduction services for people who inject drugs

“…As many PWID experience pervasive stigma and social exclusion, social distancing is a practice that many may be familiar with or even prefer (Neale, 2008 ; Schlosser & Harris, 2020 ). Despite this, protective measures and risk factors among PWID appear to be similar to the general population, and this knowledge does not necessarily translate to a willingness to fully comply with the COVID‐19 recommendations such as social distancing, home isolation and vaccinations as seen in a study conducted in Sweden between July 27 and October 2020, where 232 clients of needle exchange programs responded to COVID‐19 Health Literacy Questionnaire and 779 CoV‐2 IgG antibody tests were performed (Lindqvist et al., 2021 ). PWID face structural barriers to vaccination such as inadequate access to transportation and mistrust of health services which may impact vaccine uptake (Fisk, 2021 ; Vasylyeva et al., 2020 ).…”