A cross-sectional study of factors associated with COVID-19 testing among people who inject drugs: missed opportunities for reaching those most at risk

Abstract

Background People who inject drugs (PWID) are vulnerable to SARS-CoV-2 infection. We examined correlates of COVID-19 testing among PWID in the U.S.-Mexico border region and described encounters with services representing potential opportunities (i.e., ‘touchpoints’) where COVID-19 testing could have been offered. Methods Between October, 2020 and September, 2021, participants aged ≥18 years from San Diego, California, USA and Tijuana, Baja California, Mexico who injected drugs within the last month completed surveys and SARS-CoV-2, HIV, and HCV serologic testing. Logistic regression identified factors associated with COVID-19 testing including potential touchpoints, comorbidities and COVID-19 related misinformation and disinformation. Results Of 583 PWID, 30.5% previously had a COVID-19 test. Of 172 PWID who tested SARS-CoV-2 seropositive (30.1%), 50.3% encountered at least one touchpoint where COVID-19 testing could have been offered within the prior six months. Factors independently associated with at least two fold higher odds of COVID-19 testing were living in San Diego, recent incarceration, receiving substance use treatment, and experiencing ≥1 chronic health condition. Homelessness, having received ≥1 dose of COVID-19 vaccine, and having a HIV or HCV test since the COVID-19 epidemic began were also independently associated with having had a prior COVID-19 test. Conclusion We identified several factors independently associated with COVID-19 testing and multiple touchpoints where COVID-19 testing could be scaled up for PWID, such as SUD treatment programs and syringe service programs. Integrated health services are needed to improve access to rapid, free COVID-19 testing in this vulnerable population.

Study protocol for a pilot randomized controlled trial to increase COVID-19 testing and vaccination among people who inject drugs in San Diego County

“…In the meantime, we had completed formative research on barriers to COVID-19 testing and vaccination among PWID that led us to contemplate changes to our eligibility criteria. Specifically, we found that PWID who had been recently incarcerated or were homeless were significantly more likely to have undergone COVID-19 testing [ 13 ]. Consultations with our CSAB and in-depth interviews with PWID, supported with funding from the San Diego Center for AIDS Research, revealed that individuals in contact with the criminal justice system and homeless shelters were often subjected to mandatory (as opposed to voluntary) COVID-19 testing that had made them reluctant to engage in future voluntary testing [ 12 ].…”

“…In May 2020, La Frontera investigators received additional funding to study the prevalence and correlates of SARS-CoV2 infection in the cohort. Preliminary data showing high SARS-CoV2 seroprevalence and low COVID-19 testing and vaccination uptake informed the design of the LinkUP pilot intervention [ 8 , 11 , 13 ], which was funded in September, 2021, through the RADx® Underserved Populations (RADx-UP) initiative of the National Institutes of Health (NIH), which was created “to ensure that all Americans have access to COVID-19 testing, with a focus on communities most affected by the pandemic” [ 40 ]. Since RADxUP funding was restricted to U.S. projects, LinkUP had the goal of enrolling 150 participants into a pilot RCT focused only on La Frontera cohort participants living in San Diego County.…”

“…The active condition involves a single-session, manualized intervention that we developed based on literature review, formative research [ 8 , 12 , 13 ], and consultations with our Community and Scientific Advisory Board (CSAB) and collaborating SSP research partners. Aligned with SCT [ 36 ], key intervention strategies involve tailored education, MI, and problem-solving and planning around individual participants’ unique concerns about and barriers to COVID-19 testing and vaccination.…”

“…To help tailor the educational content to participants' needs, counselors are trained to answer questions on COVID-19 epidemiology, testing, vaccines (including booster shots), and available treatments using information drawn from CDC guidance and literature shared by our RADxUP consortium leaders. Rather than lecturing, peer counselors then use key MI techniques [37,38] to engage participants in discussion about evidence-based COVID-19 information, misinformation (e.g., "COVID-19 is no worse than the flu"), and disinformation identified in our preliminary work (e.g., "COVID-19 vaccines include a government chip or tracking device" or "can alter one's DNA") [9][10][11][12][13]. Next, peer counselors attempt to identify participants' primary concerns about COVID-19 testing and vaccination to tip their decisional balance.…”

“…People with substance use disorders, including people who inject drugs (PWID), are vulnerable to SARS-CoV-2 infection and severe disease yet have suboptimal rates of COVID-19 testing and vaccination [1][2][3][4][5][6][7][8]. Studies by our team and others have identified multilevel barriers to COVID-19 testing and vaccination among PWID, including low COVID-19 knowledge and perceived risk, institutional mistrust, addiction-related stigma, and other structural barriers to healthcare access and utilization (e.g., homelessness, limited transportation) [9][10][11][12][13]. Preliminary analyses from our ongoing, binational cohort study in the San Diego-Tijuana border region found that one third of PWID in San Diego County had been infected with SARS-CoV-2 as of June, 2021; among these individuals, two thirds had never been tested for COVID-19, and only 3% had been fully vaccinated against COVID-19 [8].…”