2F-3
INABILITY TO ACCESS HEALTH AND SOCIAL SERVICES AMONG PEOPLE WHO INJECT DRUGS IN A CANADIAN SETTING
People who inject drugs (PWID) face multiple barriers to healthcare due to substance use, medical comorbidity and social disadvantage. We evaluated access to health and social services by three of the most prevalent comorbid conditions observed among PWID, including HIV, hepatitis C (HCV) and mental health in an urban setting in Canada.
Method:
Data were derived from prospective cohorts of community-recruited PWID between 2005 and 2015. HIV and HCV diagnoses were based on lab tests, while mental health conditions and inability to access health and social services (barriers to access) were determined by participants’ self-report. We employed generalized linear mixed models controlling for confounders to examine associations between health conditions and barriers to access. Comorbid conditions were classified in several ways to examine cumulative effects and interactions between conditions: 1) occurrence of each health condition, adjusting for the other two; 2) the number of health conditions per individual; 3) eight mutually exclusive patient subgroups.
Result:
Among 2,494 participants, 1,632 (65.4%) reported barriers to access at least once over a median of six (IQR: 2, 11) semi-annual follow-up assessments. Mental health conditions were independently associated with increased barriers to access (adjusted Odds Ratio (aOR): 1.45, 95% Confidence Interval (CI): 1.32, 1.58), while HIV was not (aOR: 0.96, 95% CI: 0.85, 1.08), and HCV was associated with decreased barriers to access (aOR: 0.80, 95% CI: 0.69, 0.93). The associations between mental health conditions and barriers to access were consistent among PWID without infections (aOR: 1.35, 95% CI: 1.10, 1.65), with HCV (aOR: 1.55, 95% CI: 1.37, 1.75), and HCV and HIV co-infection (aOR: 1.36, 95% CI: 1.15, 1.60).
Conclusion:
We found a large proportion of PWID reported barriers to access, and mental health conditions were associated with increased barriers. Targeted strategies to seek and treat mental health conditions in settings that serve PWID population, and assist PWID with mental health conditions navigate the healthcare system may improve the efficiency and effectiveness of publicly-funded health and social services.