Characterizing latent classes of social support among persons who inject drugs

Temporal association of pre-pandemic perceived social support with psychological resilience and mental well-being during the COVID-19 pandemic among people with a history of injection drug use

BACKGROUND

There are limited data on whether modifiable social factors foster psychological resilience and mental well-being among people who use drugs following Big Events. We examined the temporal association of pre-pandemic perceived social support with psychological resilience and negative mental health symptoms during the COVID-19 pandemic among people with a history of injection drug use.

METHODS

Between June and September 2020, we conducted a telephone survey among 545 participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study: a community-based cohort of adults with a history of injection drug use. Leveraging data from study visits in 2018-early 2020, associations of pre-pandemic perceived social support with psychological resilience scores (range=1-5) and the probability of negative mental health symptoms during the pandemic were assessed using multivariable linear and modified Poisson regression models, respectively.

RESULTS

Participants' median age was 58 years, 38.2% were female, 83.3% identified as Black, and 30.3% were living with HIV. During the pandemic, 14.5% had low (<3) resilience scores, 36.1% experienced anxiety, and 35.8% reported increased loneliness. Compared to participants in the lowest tertile of pre-pandemic social support, participants in the highest tertile had higher mean resilience scores (β = 0.27 [95% CI = 0.12, 0.43]), a lower probability of anxiety (prevalence ratio [PR] = 0.71 [95% CI = 0.52, 0.96]), and a lower probability of increased loneliness (PR = 0.62 [95% CI = 0.45, 0.84]).

CONCLUSIONS

Pre-pandemic perceived social support was associated with greater psychological resilience and generally better mental well-being during the pandemic. Interventions that improve social support may foster psychological resilience and protect the mental well-being of people who use drugs, especially during periods of social disruption.

Estimates of people who injected drugs within the last 12 months in Belgium based on a capture-recapture and multiplier method

BACKGROUND

For Belgium, available estimates of the number of people who inject drugs (PWID) are based on data from more than fifteen years ago and apply only to those who report ever injecting drugs. As a result, no reliable baseline data exist to determine the scale of services for PWID.

METHODS

We obtained pseudo-anonymized identifier information from treatment and harm reduction service providers and a fieldwork study between February and April 2019 in Brussels. We estimated the number of PWID, defined as people who injected within the last 12 months, in Brussels using capture-recapture (CRC) methodology. To obtain national estimates, we scaled the proportion of PWID in Brussels to the total number of this population in Belgium based on two existing drug treatment registers, which were then multiplied with the result of the CRC.

RESULTS

The total population of PWID is estimated to be 703 (95 %CI 538-935) for Brussels and between 6620 (95 %CI 4711 - 8576) and 7018 (95 %CI 4794 - 9527) for Belgium.

CONCLUSIONS

These estimates provide crucial information to ensure that services to PWID are adequately maintained. They clearly indicate the need to maximize efforts to achieve the targets set by WHO for 2030 on the provision of 300 sterile needles and syringes per PWID per year, a 90 % reduction of new HCV infections, and a 65 % reduction of liver-related mortality.

Individual and social network correlates of recent treatment for substance use disorders among persons who use drugs in Baltimore, MD (2014 - 2017)

BACKGROUND

This analysis examined individual and network correlates of treatment enrollment for substance use disorders (SUDs) in the past 6 months and whether these factors varied by type(s) of drug(s) used and type of SUD treatment received.

METHODS

Between 2014 and 2017, 330 Baltimore residents who reported using heroin, crack, and/or cocaine in the past 6 months completed a survey to assess demographics, substance use, recent SUD treatment enrollment, and information about their network members. The primary outcome was recent enrollment in any type of SUD treatment (i.e., methadone maintenance, detox, residential, outpatient, and meetings/self-help) vs. none. Using logistic regression, recent SUD treatment enrollment was regressed on individual and network characteristics.

RESULTS

Overall, 214 were enrolled in some form of SUD treatment in the past 6 months (56.6% Methadone Maintenance, 29.8% Detox, 25.9% Residential, 47.8% Outpatient, and 90.7% Meetings/Self-Help). The median number of network members listed was 4.0 (interquartile range: 4-6). In the adjusted model, the odds of SUD treatment enrollment increased with each additional network member who was currently enrolled in SUD treatment (Adjusted Odds Ratio [AOR]:2.22; 95%CI:1.47-3.33). The odds of SUD treatment enrollment decreased by 35% for each additional network member who used heroin, crack, and/or cocaine and could provide them with social support (AOR:0.65; 95%CI:0.48-1.88).

CONCLUSIONS

Our findings suggest a complex link between the intersecting roles of network members and SUD treatment outcomes among persons who use drugs and the importance of collecting detailed social network information on the different domains of social support provided.