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J Clin Psychol ; 2022 Feb 07.
Article in English | MEDLINE | ID: covidwho-1669497


OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic in the United States has exacerbated a number of mental health conditions and problems related to prolonged social isolation. While COVID-19 has led to greater loneliness and a lack of social connectedness, little is known about who are the most affected and how they are impacted. Therefore, we performed a Latent Class Analysis using items from two scales - the UCLA Loneliness Scale and the Social Connectedness Scale - to characterize different experiences of loneliness and connectedness, examine their relationship with mental health and substance use symptoms, including depression, anxiety, drinking, and drug use. METHODS: Data were drawn from an anonymous one-time online survey examining the mental health of 1008 young adults (18-35 years old) during COVID-19. A latent class analysis (LCA) was conducted to observe and identify classes based on responses to loneliness and connectedness scale items, and to examine the existence of subgroups among this young adult population. RESULTS: We identified a 4-class model of loneliness and connectedness: (1) Lonely and Disconnected - highest probabilities in items of loneliness and disconnectedness, (2) Moderately Lonely and Disconnected - adaptive levels of some isolation and disconnection during COVID-19, (3) Ambivalent Feelings - displaying negative responses in particular to negatively-worded items while simultaneously affirming positively worded items, and (4) Connected and Not Lonely - lowest probabilities in items of loneliness and disconnectedness. CONCLUSION: Key findings include (1) the delineation of classes by levels of loneliness and connectedness showcasing differential mental health and substance use symptoms, (2) the utility of item-level evaluation with LCA in determining specific classes of people in need of outreach and intervention, and (3) the promise of social connection to bolster resilience in young adults.

Harm Reduct J ; 18(1): 116, 2021 11 19.
Article in English | MEDLINE | ID: covidwho-1526641


BACKGROUND: Syringe services programs (SSPs) remain highly effective, cost-saving interventions for the prevention of blood-borne infections among people who inject drugs. However, there have been restrictions regarding financial resources allocated to these programs, particularly in the US South. This study aimed to provide cost data regarding the implementation and first-year operations of an academic-based SSP utilizing fixed and mobile strategies, including the integration of onsite wound care. METHODS: We conducted a micro-costing study that retrospectively collected detailed resource utilization and unit cost data for both the fixed and mobile SSP strategies, including onsite wound care, from both healthcare and societal perspectives. A three-step approach was used to identify, measure, and value intervention costs, and cost components were categorized into implementation, variable program, and time-dependent costs. Sensitivity analysis was performed to examine the impact of SSP operational changes (i.e., needs-based distribution and opt-out HIV/HCV testing) on the cost-per-participant. Cost data we presented as overall cost and cost-per-participant adjusted to 2017 US dollars. RESULTS: A total of 452 and 129 participants enrolled in fixed and mobile SSP services, respectively. The total cost associated with implementation and first year operations for the fixed site was $407,217.22 or $729.72 per participant and $311,625.52 or $2415.70 per participant for the mobile unit. The largest cost component for both modalities was time-dependent costs (personnel and overhead), while intervention materials (syringes, injection equipment, naloxone) were less than 15% of the total program cost. DISCUSSION/CONCLUSION: Implementation and operation of new SSP models continue to be low cost compared to treatment for the multitude of harms PWID face without access to evidence-based prevention. Future cost-effectiveness and cost-benefit analyses integrating a comprehensive SSP model within an academic institution, including onsite wound care and other medical services, will provide a more comprehensive understanding of this model, and state-level policy action must be taken to lift the prohibition of state and local funds for the implementation, sustainability, and maintenance of these programs in Florida.

HIV Infections , Substance Abuse, Intravenous , Academic Medical Centers , HIV Infections/prevention & control , Humans , Needle-Exchange Programs , Retrospective Studies , Syringes
Drug Alcohol Depend ; 228: 108977, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1372960


BACKGROUND: Although national syndromic surveillance data reported declines in emergency department (ED) visits after the declaration of the national stay-at-home order for COVID-19, little is known whether these declines were observed for suspected opioid overdose. METHODS: This interrupted time series study used syndromic surveillance data from four states participating in the HEALing Communities Study: Kentucky, Massachusetts, New York, and Ohio. All ED encounters for suspected opioid overdose (n = 48,301) occurring during the first 31 weeks of 2020 were included. We examined the impact of the national public health emergency for COVID-19 (declared on March 14, 2020) on trends in ED encounters for suspected opioid overdose. RESULTS: Three of four states (Massachusetts, New York and Ohio) experienced a statistically significant immediate decline in the rate of ED encounters for suspected opioid overdose (per 100,000) after the nationwide public health emergency declaration (MA: -0.99; 95 % CI: -1.75, -0.24; NY: -0.10; 95 % CI, -0.20, 0.0; OH: -0.33, 95 % CI: -0.58, -0.07). After this date, Ohio and Kentucky experienced a sustained rate of increase for a 13-week period. New York experienced a decrease in the rate of ED encounters for a 10-week period, after which the rate began to increase. In Massachusetts after a significant immediate decline in the rate of ED encounters, there was no significant difference in the rate of change for a 6-week period, followed by an immediate increase in the ED rate to higher than pre-COVID levels. CONCLUSIONS: The heterogeneity in the trends in ED encounters between the four sites show that the national stay-at-home order had a differential impact on opioid overdose ED presentation in each state.

COVID-19 , Drug Overdose , Opiate Overdose , Analgesics, Opioid , Drug Overdose/epidemiology , Emergency Service, Hospital , Humans , Pandemics , SARS-CoV-2
Clin Infect Dis ; 72(11): e828-e834, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1249293


BACKGROUND: Widespread viral and serological testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may present a unique opportunity to also test for human immunodeficiency virus (HIV) infection. We estimated the potential impact of adding linked, opt-out HIV testing alongside SARS-CoV-2 testing on the HIV incidence and the cost-effectiveness of this strategy in 6 US cities. METHODS: Using a previously calibrated dynamic HIV transmission model, we constructed 3 sets of scenarios for each city: (1) sustained current levels of HIV-related treatment and prevention services (status quo); (2) temporary disruptions in health services and changes in sexual and injection risk behaviors at discrete levels between 0%-50%; and (3) linked HIV and SARS-CoV-2 testing offered to 10%-90% of the adult population in addition to Scenario 2. We estimated the cumulative number of HIV infections between 2020-2025 and the incremental cost-effectiveness ratios of linked HIV testing over 20 years. RESULTS: In the absence of linked, opt-out HIV testing, we estimated a total of a 16.5% decrease in HIV infections between 2020-2025 in the best-case scenario (50% reduction in risk behaviors and no service disruptions), and a 9.0% increase in the worst-case scenario (no behavioral change and 50% reduction in service access). We estimated that HIV testing (offered at 10%-90% levels) could avert a total of 576-7225 (1.6%-17.2%) new infections. The intervention would require an initial investment of $20.6M-$220.7M across cities; however, the intervention would ultimately result in savings in health-care costs in each city. CONCLUSIONS: A campaign in which HIV testing is linked with SARS-CoV-2 testing could substantially reduce the HIV incidence and reduce direct and indirect health care costs attributable to HIV.

COVID-19 , Epidemics , HIV Infections , Adult , COVID-19 Testing , Cities , Cost-Benefit Analysis , HIV , HIV Infections/diagnosis , HIV Infections/epidemiology , Humans , SARS-CoV-2
AIDS Behav ; 25(12): 4000-4007, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1245665


Black women living with HIV (BWLWH) in the U.S. face microaggressions based on race, gender, HIV-status, and sexual orientation. We examined changes in daily microaggressions and related distress among 143 BWLWH in Miami, FL. Microaggression-related distress increased from 52% at baseline/October, peaked at 70% during the holidays (November/December), declined to 55% in March when COVID-19 social distancing began, and peaked to 83% in June/July 2020 during widespread Black Lives Matters protests. Baseline viral suppression was associated with lower microaggressions across the 9-months. Microaggression-related distress may change due to social context and research is needed on microaggressions and viral load overtime.

RESUMEN: Las mujeres de raza negra que viven con el VIH (MNVV) en los EE. UU. enfrentan microagresiones basadas en la raza, el género, el estado serológico del VIH y la orientación sexual. Examinamos los cambios en las microagresiones diarias y el estrés relacionado entre 143 MNVV en Miami, FL. El estrés relacionado con la microagresión aumentó del 52% en la línea de base/octubre, alcanzó un máximo del 70% durante las vacaciones (noviembre/diciembre), disminuyó al 55% en marzo cuando comenzó el distanciamiento social por el COVID-19 y alcanzó un máximo del 83% en junio/julio de 2020 durante las protestas generalizadas de Black Lives Matters. La supresión viral inicial se asoció con menores microagresiones durante los 9 meses. El estrés relacionada con la microagresión puede cambiar debido al contexto social y se necesitan investigaciones sobre las microagresiones y la carga viral con el tiempo.

COVID-19 , HIV Infections , Racism , Aggression , Female , HIV Infections/epidemiology , Humans , Male , Pandemics , SARS-CoV-2
J Psychoactive Drugs ; 53(1): 1-9, 2021.
Article in English | MEDLINE | ID: covidwho-894475


As COVID-19 converges with loneliness and addiction epidemics in the US, both public health and mental health experts forecast dramatic increases in substance use and mental health conditions. This cross-sectional study evaluated relationships of loneliness with depression, anxiety, alcohol use, and drug use during COVID-19, and assessed perceived increases in these symptoms in young adults. Between April 22 and May 11, 2020, 1,008 participants ages 18-35 were recruited through social media to a one-time, online anonymous survey. Symptomatology was assessed using six scales. Perceived changes since COVID-19 were evaluated using 5-point Likert scales. Forty-nine percent of respondents reported loneliness scores above 50; 80% reported significant depressive symptoms; 61% reported moderate to severe anxiety; 30% disclosed harmful levels of drinking. While only 22% of the population reported using drugs, 38% reported severe drug use. Loneliness was associated with higher levels of mental health symptomatology. Participants reported significant increases across mental health and substance use symptoms since COVID-19. While direct impacts of COVID-19 could only be calculated with pre-pandemic assessments of these symptoms, estimates indicate elevated psychosocial symptomatology and suggest that symptoms could have worsened since the pandemic. Findings underscore the importance of prevention and intervention to address these public health problems.

COVID-19 , Loneliness/psychology , Mental Health/statistics & numerical data , Pandemics , Substance-Related Disorders/epidemiology , Adolescent , Adult , Age Factors , Alcoholism/epidemiology , Alcoholism/psychology , Anxiety/epidemiology , Anxiety/psychology , Cross-Sectional Studies , Depression/epidemiology , Depression/psychology , Female , Health Status , Humans , Male , Psychiatric Status Rating Scales , Sex Factors , Surveys and Questionnaires , United States/epidemiology , Young Adult