Inability to access health and social services associated with mental health among people who inject drugs in a Canadian setting.
People who inject drugs (PWID) face barriers to healthcare due to reasons including comorbidity. We evaluated access to health and social services by three of the most prevalent comorbid conditions among PWID: HIV, hepatitis C (HCV), and mental health, in an urban setting in Canada.



Data were derived from prospective cohorts of community-recruited PWID between 2005 and 2015. HIV and HCV serostatuses were based on antibody 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.



Among 2494 participants, 1632 (65.4%) reported barriers to access at least once over a median of seven (IQR: 3, 12) semi-annual assessments. Mental health conditions were independently associated with increased odds of reporting barriers (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 odds (aOR: 0.80, 95% CI: 0.69, 0.93). The associations between mental health conditions and barriers to access were consistent among PWID without HIV/HCV (aOR: 1.35, 95% CI: 1.10, 1.65), with HCV mono-infection (aOR: 1.55, 95% CI: 1.37, 1.75), and HCV/HIV co-infection (aOR: 1.36, 95% CI: 1.15, 1.60).



Targeted strategies to seek and treat mental health conditions in settings that serve PWID, and assist PWID with mental health conditions in navigating healthcare system may improve the publicly-funded health and social services.
BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. Electronic address: lwang@cfenet.ubc.ca.
Linwei
L
Wang
BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. Electronic address: dpanagiotoglou@cfenet.ubc.ca.
Dimitra
D
Panagiotoglou
BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. Electronic address: jmin@cfenet.ubc.ca.
Jeong Eun
JE
Min
BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; School of Public Policy, Simon Fraser University, Simon Fraser University at Harbour Centre, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada. Electronic address: uhri-kd@cfenet.ubc.ca.
Kora
K
DeBeck
BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada. Electronic address: uhri-mjsm@cfenet.ubc.ca.
M J
MJ
Milloy
BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada. Electronic address: uhri-tk@cfenet.ubc.ca.
Thomas
T
Kerr
BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada. Electronic address: uhri-kh@cfenet.ubc.ca.
Kanna
K
Hayashi
BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. Electronic address: bnosyk@cfenet.ubc.ca.
Bohdan
B
Nosyk
D000328:Adult; D002170:Canada; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000628:therapy*; D006296:Health Services; D006297:Health Services Accessibility; D006526:Hepatitis C / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000628:therapy*; D008603:Mental Health; D008605:Mental Health Services; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012947:Social Work; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000628:therapy*
Comorbidity; Drug use; HCV; HIV; Mental health conditions; Service access