Considerations for Equitable Distribution of Digital Healthcare for People Who Use Drugs

Background: Telehealth holds the potential to expand healthcare access for people who use drugs (PWUD). However, approaches to increase PWUDs' access to digital healthcare are not well understood. We studied digital healthcare accessibility among PWUD. Methods: We employed respondent-driven sampling to recruit 162 PWUD in Athens, Greece to collect data via a structured questionnaire. Participants were aged at least 18 years and had an injection drug use (IDU) history. We assessed current internet and computer access, and experience with telemedicine. We utilized logistic regression to evaluate sociodemographic associations. Results: Participants' mean (standard deviation) age was 45.9 (8.8) years, 84.0% were male, 90.1% Greek, 77.8% reported IDU within the past year, 85.2% were not linked to opioid treatment, and 50.0% were currently experiencing homelessness. Only 1.9% had experience and 46.3% had familiarity with telemedicine. Internet and computer access were reported by 66.0% and 31.5% of participants, respectively. Compared to participants with secure housing, those currently experiencing homelessness reported decreased internet (50.6% vs 81.5%, p<0.001) and computer access (11.1% vs 51.9%, p<0.001). Multivariable analyses revealed that older age (per 1-year increase: odds ratio [OR]=0.94, 95% confidence interval [CI] [0.89, 0.99], p=0.03), IDU within the past year (0.29 [0.10, 0.88], p=0.03), and homelessness (0.29, [0.13, 0.65], p=0.003) were associated with lower odds of internet access. Homelessness was associated with lower odds of computer access (0.17, [0.07, 0.41], p<0.001). Conclusions: Internet and infrastructure challenges, homelessness, and digital literacy gaps should be considered to bridge the digital divide and ensure equitable digital healthcare distribution for PWUD.