# Impact of the Coronavirus Disease 2019 Pandemic on Substance Use Disorder Risk Among People Living With Human Immunodeficiency Virus (HIV) Enrolled in HIV Care in the United States: An Interrupted Time Series Analysis

## TL;DR

The study found that substance use disorder risk among people with HIV in the US increased significantly during the pandemic, especially after shelter-in-place mandates, with more use of fentanyl and methamphetamine.

## Contribution

This study provides novel evidence on the impact of the pandemic on substance use trends among people with HIV using an interrupted time series analysis.

## Key findings

- Moderate/high SUD risk increased from 24% pre-SIP to 43% post-SIP.
- Post-SIP saw increased use of fentanyl, methamphetamine, and heroin, and decreased use of prescription opioids and sedatives.
- Substance use treatment access decreased post-SIP compared to pre-SIP.

## Abstract

Rising overdose deaths globally and increased social isolation during the coronavirus disease 2019 (COVID-19) pandemic may have disproportionately impacted people with human immunodeficiency virus (PWH) with substance use disorders (SUD). We examined trends in SUD risk among PWH before and after the COVID-19 shelter-in-place (SIP) mandate.

Data were collected between 2018 and 2022 among PWH enrolled across 8 US sites in the Centers for AIDS Research Network of Integrated Clinical Systems cohort. We evaluated changes in moderate/high SUD risk after SIP using interrupted time series analyses.

There were 7126 participants, including 21 741 SUD assessments. The median age was 51 (interquartile range, 39–58) years; 12% identified as Hispanic or Latino/Latina, 46% Black/African American, and 46% White. Moderate/high SUD risk increased continuously after the pandemic's onset, with 43% (95% confidence interval [CI], 40%–46%) endorsing moderate/high SUD risk post-SIP, compared to 24% (95% CI, 22%–26%) pre-SIP (P < .001). There were increases in the use of heroin, methamphetamine, and fentanyl, and decreases in prescription opioids and sedatives post-SIP. Further, there was a decrease in reported substance use treatment post-SIP compared to pre-SIP (P = .025).

The rising prevalence of SUD through late 2022 could be related to an increase in isolation and reduced access to substance use and HIV treatment caused by disruptions due to COVID-19. A renewed investment in integrated substance use treatment is vital to address the combined epidemics of substance use and HIV following the COVID-19 pandemic and to support resilience in the face of future disruptions.

At-risk substance use among people with HIV (PWH) increased over 2 years following COVID-19 shelter-in-place (SIP), with increased fentanyl and methamphetamine use. PWH successfully accessing substance use treatment services decreased post-SIP, highlighting the need for integrated substance use and HIV treatment.