Inability to access health and social services associated with mental health among people who inject drugs in a Canadian setting

Abstract

Background People who inject drugs (PWID) face barriers to healthcare due to reasons including comorbidity. We evaluated access to health and social services by three of the most prevalent comorbid conditions among PWID: HIV, hepatitis C (HCV), and mental health, in an urban setting in Canada. Methods Data were derived from prospective cohorts of community-recruited PWID between 2005 and 2015. HIV and HCV serostatuses were based on antibody tests, while mental health conditions and inability to access health and social services (barriers to access) were determined by participants’ self-report. We employed generalized linear mixed models controlling for confounders to examine associations between health conditions and barriers to access. Results Among 2494 participants, 1632 (65.4%) reported barriers to access at least once over a median of seven (IQR: 3, 12) semi-annual assessments. Mental health conditions were independently associated with increased odds of reporting barriers (adjusted Odds Ratio (aOR): 1.45, 95% Confidence Interval (CI): 1.32, 1.58), while HIV was not (aOR: 0.96, 95% CI: 0.85, 1.08), and HCV was associated with decreased odds (aOR: 0.80, 95% CI: 0.69, 0.93). The associations between mental health conditions and barriers to access were consistent among PWID without HIV/HCV (aOR: 1.35, 95% CI: 1.10, 1.65), with HCV mono-infection (aOR: 1.55, 95% CI: 1.37, 1.75), and HCV/HIV co-infection (aOR: 1.36, 95% CI: 1.15, 1.60). Conclusions Targeted strategies to seek and treat mental health conditions in settings that serve PWID, and assist PWID with mental health conditions in navigating healthcare system may improve the publicly-funded health and social services.

Polydrug use and its association with drug treatment outcomes among primary heroin, methamphetamine, and cocaine users

“…I. Hser, Evans, Huang, Brecht, & Li, 2008; UNODC, 2012; Wang et al, 2016). In addition, high levels of polydrug use have been reported among people who use illicit drugs (PWUD) in a wide variety of treatment and community settings internationally (Ball & Ross, 1991; Booth, Leukefeld, Falck, Wang, & Carlson, 2006; Byqvist, 2006; Darke & Hall, 1995; Ives & Ghelani, 2006; Leri, Bruneau, & Stewart, 2003; Leri et al, 2005).…”

HCV infection status and care seeking among people living with HIV who use drugs in Vietnam

“…Future studies addressing PLHWDU's healthcare-seeking challenges should pay attention to the role of mental health in HCV diagnosis and service utilization. We echo other researchers in the integration of psychological support services within the existing HIV care and infectious disease treatment systems to facilitate healthcare access and utilization for PLHWUD (Chu et al, 2016;Wang et al, 2016).…”

“…Mental health challenges, which are common among PLHWUD (Baum et al, 2008;Fialho et al, 2017), further complicate the aforementioned barriers to treatment access (Beaulieu et al, 2018;Mojtabai et al, 2014;Souliotis et al, 2017). Mental health conditions were found to be consistently associated with increased barriers to access among PLHWUD, with or without HCV-coinfection (Wang et al, 2016). One explanation is that substance use disorders and mental illnesses are considered as contraindications to HCV therapy, due to the potential neuropsychiatric effects of interferon (Hepworth et al, 2013).…”

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“…AI/AN communities participating in this project have clearly identified barriers and opportunities for change in services and treatment programs for PWID. Yet, many of these same barriers are not much different from identified barriers and opportunities for non-AI/AN communities, and include lack of access to health services, lack of provider education, and social stigma (Wang et al, 2016;Lang et al, 2013). This would suggest that, regardless of specific AI/AN-cultural needs for intervention and competency, there are lessons all health care services should learn and implement to better reach PWID.…”