ABSTRACT
Background: The COVID-19 pandemic resulted in disruptions to health care services. Vulnerable populations, including people living with HIV (PLHIV), may have experienced unique challenges when accessing medical care. The objective of this study was to evaluate the impact of social disruptions on health care visits among Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study (MWCCS) participants. Method(s): A survey collecting data on missed health care visits and social disruptions (i.e., disruptions in employment, childcare, financial support, housing, and health insurance) during the pandemic was administered via telephone to MWCCS participants 1-3 times from March and September 2020. Logistic regression models adjusted for sociodemographics and HIV-status were used to test the association between social disruptions and three medical care interruption outcomes (i.e., missed healthcare appointment, interruption of mental health care, and interruption of substance use care). Result(s): Surveys (n=10,076) were conducted among 2238 PLHIV (61% women) and 1427 people living without HIV (PLWoH) (41% women). Overall, 42% of participants reported disruptions in health care with no significant difference by HIV status. Among participants receiving mental health care services and substance use treatment, 52% and 36% reported interruptions of care, respectively. Participants reporting >= 2 social disruptions were more likely to report missed health care appointments (adjusted odds ratio [aOR]: 1.81, 95% confidence interval [CI]: 1.54-2.13), and interruptions in mental health care [aOR: 2.42, 95%CI: 1.85-3.17) or substance use treatment (aOR: 1.97, 95%CI: 1.26-3.09), compared to those reporting no disruptions. Participants who were unemployed were more likely to miss health care appointments (aOR:1.46, 95% CI: 1.25-1.71) and report disruptions in mental health care (aOR: 2.02, 95% CI: 1.54-2.66) compared to those who were employed. PLHIV reporting >= 2 social disruptions were at increased risk for missed health care appointments (aOR 1.92, 95%CI: 1.56-2.36) and disruptions in mental health care (aOR: 2.54, 95%CI: 1.83-3.53 (Table 1). Conclusion(s): Social disruptions as a result of the COVID-19 pandemic have adversely impacted the receipt of health care among PLHIV and PLWoH, including the receipt of treatment for mental health and substance abuse. Providing childcare, financial support, housing, and health insurance may reduce disruptions in care and improve health outcomes.
ABSTRACT
Background. Early in the COVID-19 pandemic, many clinical studies pivoted to remote research visits, which have a higher non-response rate compared to in-person assessments. Survey non-response can bias estimates of alcohol and substance use prevalence. Our objective was to identify factors associated with responding to an alcohol and substance use phone survey administered during the COVID-19 pandemic to women enrolled in the MACS/WIHS Combined Cohort Study, a multicenter U.S. prospective cohort of adults living with and without HIV. Methods. We assessed associations of pre-pandemic (April-Sept. 2019) sociodemographic factors, HIV status, housing status, depressive symptoms, alcohol use, and substance use measures with response to a pandemic (Aug.-Sept. 2020) phone survey using multivariable logistic regression. Response probability weights generated from the regression model were applied to the sample and prevalence estimates of risky drinking (> 7 drinks/week or > 3 drinks/day) and substance use (opioids, stimulants, sedatives) in the COVID-19 pandemic were compared to the unweighted sample. Results. Of 1,834 women with pre-pandemic data, 62% were of Black race, 46% had an annual income < $12K, 71% were living with HIV and the mean age was 52.4 (SD 9.3) years. The phone survey response rate was 77.5%. In the adjusted model, the odds of responding were lower at research sites in the Western (aOR 0.35 95% CI 0.21-0.57) and Southern US (aOR 0.29 95% CI 0.19-0.44, ref=Midwest), in women of Hispanic ethnicity (aOR 0.47 95% CI 0.33-0.66, ref=Black race), and in those who reported substance use (aOR 0.62 95% CI 0.40-0.95). By contrast, the odds were higher for women of white race (aOR 1.63 95% CI 1.02-2.70) and those with stable housing (aOR 1.71 95% CI 1.22-2.39). Un weighted versus weighted prevalence estimates were 11.1% vs. 11.6% for risky drinking and 6.1% vs. 6.9% for substance use. Conclusion. Among a sample of socioeconomically disadvantaged women, women of Hispanic ethnicity, and those who were unstably housed and reported substance use at baseline had lower odds of responding to an alcohol and substance use phone survey conducted early in the COVID-19 pandemic. As remote survey methods become more common, investigators should ensure that data remain representative of the target population.