Colliding Epidemics During an Opioid Crisis: Impact of the COVID-19 Pandemic on Determinants of HIV and HCV Transmission Among People Who Inject Drugs

PROJECT SUMMARY/ABSTRACT The U.S. plans to End the HIV Epidemic (EHE) and eliminate hepatitis C virus (HCV) infection by 2030. While progress has been made in many groups including people who inject drugs (PWID), recent outbreaks of HCV and HIV infection have been documented among PWID in the U.S and HCV incidence is increasing nationally

due to the opioid crisis. The COVID-19 pandemic, including the public health response, has resulted in disruptions in access to services and created an environment that enables substance use. Indeed, the COVID- 19 pandemic may further threaten the U.S.' plan to EHE and eliminate HCV by exacerbating the opioid crisis.

The objective of this study is to assess the short- and long-term impacts of the COVID-19 pandemic on individual- and community-level determinants of HIV and HCV transmission among PWID in Baltimore, MD. The specific aims are to: (1) identify individual-level predictors of high-risk injection practices among PWID

during the COVID-19 pandemic, (2) examine trends in harm reduction utilization and identify associated barriers and facilitators among PWID during the COVID-19 pandemic, and (3) evaluate the impact of the COVID-19 pandemic on the population-level prevalence of HIV and HCV viremia among PWID. These aims

will be achieved by leveraging data from one of the largest and longest running cohorts of community-based PWID worldwide—the AIDS Linked to the IntraVenous Experience (ALIVE) study in Baltimore, MD. Aim 1 will identify pre-pandemic sociodemographic, behavioral, psychosocial, and biological factors associated with high-

risk injection practices during the pandemic using modified Poisson regression with generalized estimating equations. Aim 2 will use a mixed-methods sequential explanatory approach to examine changes in the population-level uptake of needle/syringe exchange services and medication for opioid use disorder before and

during different phases of the pandemic (2015-2021). In-depth interviews will be conducted with 25-30 PWID to explore new barriers and facilitators to service utilization. Aim 3 will use an interrupted time-series analytic approach to estimate the effect of the pandemic on the prevalence of HIV viremia and HCV viremia (2015-

2023). This study will inform whether the pandemic poses a major threat to the local and national goals to EHE and eliminate HCV infection. This study will also inform the implementation of surveillance and programmatic strategies to mitigate HIV/HCV transmission during the ongoing pandemic and opioid crisis as well as during

future periods of unrest and instability. The proposed study, which covers a high priority area for NIDA, will serve as the doctoral dissertation for Mr. Eshan Patel, a PhD student in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health. A comprehensive training program including mentored

research training from experts in HIV, HCV, and substance use epidemiology, psychosocial statistics, qualitative research, and causal inference will provide the applicant a tailored experience to achieve his goal of becoming an academic epidemiologist that contributes to the elimination of HIV and HCV among PWID.