The Impact of the COVID-19 Pandemic on Substance Use Disorders Risk among People Living with HIV Enrolled in HIV Care in the United States: an Interrupted Time Series Analysis

Abstract

With rising overdose deaths globally and the social isolation of the COVID-19 pandemic, people with HIV (PWH) with substance use disorders (SUD) may have been disproportionately impacted. We examined whether there was a change in SUD risk among PWH before and after the COVID-19 shelter-in-place (SIP) mandate. Data were collected between 2018-2022 among PWH enrolled across 8 U.S. sites in the Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) cohort. We evaluated changes in reported moderate/high SUD risk after SIP using interrupted time series analyses fit with a mixed-effects logistic regression model. There were 7,126 participants, including 21,741 SUD assessments. The median age was 51 (IQR=39-58); 12% identified as Hispanic or Latino/a; 46% identified as Black/African American, and 46% White. Moderate/high SUD risk increased continuously after the pandemic’s onset, with 43% (95%CI=40-46%) endorsing moderate/high SUD risk post-SIP, compared to 24% (95%CI=22-26%) pre-SIP (p<.001). There were statistically significant increases in the use of heroin, methamphetamine, and fentanyl, and decreases in prescription opioids and sedatives post-SIP. Further, there was a significant decrease in reported substance use treatment post-SIP compared to pre-SIP, (p=.025). The rising prevalence of SUD through late 2022 could be related to an increase in isolation, depression, and reduced access to substance use and HIV treatment caused by disruptions due to the pandemic. A renewed investment in integrated substance use treatment is vital to address the combined epidemics of substance use and HIV following the COVID pandemic and to support resilience in the face of future disruptions.