Clinical Scorecard: Effects of COVID-19-Related Service Interruptions and Behavioral Shifts on the Transmission of Hepatitis C Virus and HIV Among Individuals Who Inject Drugs: A Modeling Analysis

At a Glance

Key Highlights

• COVID-19 pandemic caused disruptions to healthcare and harm reduction services critical for PWID, including reduced testing, treatment, and prevention access.
• Behavioral changes during the pandemic included accelerated injection cessation overall, increased injection frequency among continuing injectors, smaller drug-use networks, and reduced injecting with others.
• Modeling incorporating both service disruptions and behavioral changes showed that behavioral shifts could mitigate or offset increased HCV and HIV transmission risks caused by service interruptions.

Guideline-Based Recommendations

Diagnosis

• Maintain and prioritize HCV and HIV testing services for PWID even during pandemic-related disruptions.

Management

• Ensure continuity and accessibility of harm reduction services such as syringe service programs and medication for opioid use disorder.
• Adapt service delivery policies to maintain engagement and treatment initiation for HCV and HIV among PWID during public health emergencies.

Monitoring & Follow-up

• Monitor changes in injection behaviors and drug-use networks to inform transmission risk assessments.
• Track HCV and HIV prevalence and incidence trends among PWID to identify outbreak risks and service gaps.

Risks

• Service disruptions can increase HCV and HIV transmission risk due to reduced prevention and treatment access.
• Behavioral shifts such as increased injection frequency and smaller social networks may alter transmission dynamics and should be considered in risk evaluations.

Patient & Prescribing Data

People who inject drugs enrolled in community-based cohorts similar to ALIVE study participants.

Pandemic-related service interruptions reduced treatment initiation and retention for HCV and HIV; behavioral changes may partially offset increased transmission risk but do not replace the need for sustained service access.

Clinical Best Practices

• Integrate behavioral surveillance with service delivery data to understand and respond to transmission dynamics among PWID.
• Maintain flexible and accessible harm reduction and treatment services during public health crises to minimize service disruption impacts.
• Use modeling informed by empirical behavioral data to guide intervention strategies targeting PWID populations.

References

• ALIVE Study Overview
• CDC HIV Surveillance Report 2021