A cross-sectional study of factors associated with COVID-19 testing among people who inject drugs: missed opportunities for reaching those most at risk
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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.
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SciScore for 10.1101/2022.01.04.22268749: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: [17] Protocols were approved by institutional review boards at the University of California San Diego and Xochicalco University in Tijuana.
Consent: Informed consent was obtained from all human participants.Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Antibodies Sentences Resources Serum samples were batched and tested weekly by Genalyte® (San Diego, CA), using their Maverick™ Multi-Antigen Serology Panel [33] that detects IgG and IgM antibodies to five SARS-CoV-2 antigens. IgMsuggested: None[34] HIV and HCV Serology: Rapid HIV and HCV tests were conducted using the Miriad® HIV/HCV Antibody InTec Rapid … SciScore for 10.1101/2022.01.04.22268749: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: [17] Protocols were approved by institutional review boards at the University of California San Diego and Xochicalco University in Tijuana.
Consent: Informed consent was obtained from all human participants.Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Antibodies Sentences Resources Serum samples were batched and tested weekly by Genalyte® (San Diego, CA), using their Maverick™ Multi-Antigen Serology Panel [33] that detects IgG and IgM antibodies to five SARS-CoV-2 antigens. IgMsuggested: None[34] HIV and HCV Serology: Rapid HIV and HCV tests were conducted using the Miriad® HIV/HCV Antibody InTec Rapid Anti-HCV Test (Avantor Anti-HCVsuggested: NoneSoftware and Algorithms Sentences Resources All statistical analyses were conducted using SAS, version 9.4. SASsuggested: (SASqPCR, RRID:SCR_003056)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:[43] Limitations: This study was limited by the cross-sectional nature of the analysis, which precludes causal inferences. Although this was a binational study, sampling was non-random and results may not generalize to other samples of PWID. Our survey relied on self-report and may have been subject to socially desirable responding or recall challenges. We could not differentiate between circumstances in which COVID-19 testing was mandatory (e.g., in prison, jails, detention centers, and some homeless shelters) versus situations in which testing was voluntary and sought out by participants. These contextual factors are important to explore in future studies. Similarly, we did not ask participants if they were required to pay for COVID-19 testing. Noting that the availability and cost of COVID-19 testing may have changed over time, we controlled for time in our analysis. Statistical power may have limited our ability to detect some associations. For example, we did not find that attending SSPs was independently associated with COVID testing, which could be related to the low number of participants who had recently accessed SSPs. During the COVID-19 epidemic, many U.S. SSPs reduced their services or hours of operation, [25] or reduced provision of other health services. [44] In California, free rapid COVID-19 testing only became available through mobile SSPs after data collection for this study ended.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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