COVID-19 has disproportionately impacted persons in densely populated areas, especially those with chronic conditions, OUD, and racial-ethnic minorities, who have reduced access to health care services [2,3,4, 19]. The present study examined the extent to which these sociodemographic characteristics have similarly affected individuals with OUD and PWID regarding HIV/STI testing, availability of PrEP, and ability to secure appointments with health care professionals. Our results indicate that most participants did not report reduced access to blood testing or injection equipment due to COVID-19. Contrarily, almost half of the individuals surveyed expressed difficulties in obtaining appointments with HIV counselors or doctors, which is troubling as these are critical resources for treatment maintenance among PWID. Our hypotheses were partially supported, indicating that structural improvements related to counselor and doctor appointments require drastic improvements but that testing services to this population have not been completely disrupted by the COVID-19 pandemic.
Surprisingly, within this sample of persons enrolled in MOUD, the vast majority reported that for those who desired to test, access to HIV or STI testing had not changed because of COVID-19 restrictions, with less than 16% reporting decreased access to either testing. Although the need for HVI or STI testing may have been reduced due to social isolation caused by COVID-19 restrictions, the availability of stable testing resources is nevertheless significant [7, 16]. On the other hand, concomitant antiretroviral therapy- (ART) non-adherence and decreased confidence in attending HIV follow-up visits have also been reported to be growing . Rising evidence is also corroborating the potential surge in opioid overdose among PWID and decrease in bystander rescue during the pandemic [21,22,23] which can also potentially be due to medication unavailability. This pool of dynamics, coupled with the closure of substance abuse clinics and the reallocation of services to support COVID-19 efforts, could result in deleterious effects on HIV prevention efforts and HIV transmission .
The results pertaining to access to PrEP were less optimistic, with one-quarter of individuals on PrEP reporting difficulty getting a prescription from their provider and, to a lesser extent, filling prescriptions at their local pharmacy. These factors may have contributed to individuals deciding to stop taking PrEP. However, it is equally likely that individuals perceived themselves at lower risk during this time frame due to less risky sexual behaviors, less casual sex, fewer sexual partners, and less group sex because of COVID isolation and quarantine efforts .
In the context of ongoing challenges in harm reduction programs such as the closure of syringe service programs (SSPs) or significant reductions in SSP working hours , PWID are at increased risk for HIV transmission and opioid overdoses that could be lethal, as discussed earlier. As in-person meetings with medical providers are limited during the COVID-19 pandemic, mHealth interventions could constitute a suitable alternative to deliver care to PLWH and patients with OUD as they have a high level of satisfaction from both patient and provider perspectives [21, 26]. Telehealth services should therefore be encouraged when available and amenable to be delivered in an appropriate manner . Although more efforts are still needed in order to develop strategies that would maintain access to care to this population during this pandemic , one particular area in which telemedicine could be especially useful is in the partnering with non-clinical community-based service providers which can in turn improve access to care for those patients who do not seek care at the clinic as often as others.
Potential improvement in HIV and OUD services can also be implemented at the MOUD clinic level. Counselors and providers can be educated about the arising HIV transmission and opioid overdose risks, and about the importance of testing and referral to harm reduction services. Providers can also help patients plan for HIV testing by suggesting mobile clinic locations for example or rapid testing.
Finally, although we analyzed the data for differences between gender, age, sexual identity, and racial-ethnic identity, we found none, which is counter to recent studies demonstrating significant disparities along racial/ethnic lines, at least concerning COVID 19 related services and outcomes . It is plausible our contrasting findings may be a result of the fact that our participants are in MOUD, and accordingly, avenues to treatment were established prior to the COVID-19 pandemic, minimizing differences observed in other studies of sociodemographic risk factors and COVID-19 .
While this study provides valuable and informative data from a vulnerable and hard-to-reach population, it does have limitations. This study is limited by its sample size and the targeting of PWID who are undergoing treatment. Consequently, access to services for persons not already in treatment cannot be ascertained. In addition, although participants were surveyed by phone, no open-ended responses regarding access or lack thereof were qualitatively analyzed. Lastly, sampling bias may be present due to the time frame the surveys were completed (May–October 2020), in which COVID-19 restrictions may have varied.
The present study adds to the knowledge base for ensuring against gaps in health services for PWID and persons with OUD by identifying the areas with more dire need. While HIV/STI testing and access to PrEP remain important, increasing telehealth appointments for both HIV counselors, case managers, and doctors to help these individuals remain in MMT is paramount.