Prevalence and correlates of SARS-CoV-2 seropositivity among people who inject drugs in Baltimore, Maryland

• Published in: Drug and alcohol dependence reports Vol. 8; p. 100184
• Main Authors: Patel, Eshan U., Mehta, Shruti H., Genberg, Becky L., Baker, Owen R., Schluth, Catherine G., Astemborski, Jacquie, Fernandez, Reinaldo E., Quinn, Thomas C., Kirk, Gregory D., Laeyendecker, Oliver
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.09.2023; Elsevier
• Subjects: COVID-19; Disparities; Full Length Report; People who inject drugs; People who use drugs; Psychiatric/Mental Health; Substance use; Vaccination; COVID-19; Substance use; People who inject drugs; Disparities; People who use drugs; Vaccination; substance use; COVID-19, people who inject drugs, people who use drugs; vaccination, disparities
• ISSN: 2772-7246; 2772-7246
• DOI: 10.1016/j.dadr.2023.100184

•Prevalence of infection-induced SARS-CoV-2 antibodies was 26%.•Prevalence of infection and/or vaccination-induced SARS-CoV-2 antibodies was 63%.•The prevalence and magnitude of SARS-CoV-2 antibodies increased over time.•Substance use-related behaviors were not associated with SARS-CoV-2 antibodies.•Disparities in seroprevalence highlighted groups that need greater vaccine efforts. SARS-CoV-2 serosurveys can help characterize disparities in SARS-CoV-2 infection and identify gaps in population immunity. Data on SARS-CoV-2 seroprevalence among people who inject drugs (PWID) are limited. We conducted a cross-sectional study between December 2020 and July 2022 among 561 participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study—a community-based cohort of current and former PWID in Baltimore, Maryland. Serum samples were assayed for infection-induced anti-nucleocapsid (anti-N) and infection and/or vaccination-induced anti-spike-1 (anti-S) SARS-CoV-2 IgG. We estimated adjusted prevalence ratios (aPR) via modified Poisson regression models. The median age was 59 years, 35% were female, 84% were non-Hispanic Black, and 16% reported recent injection drug use. Anti-N antibody prevalence was 26% and anti-S antibody prevalence was 63%. Anti-N and anti-S antibody prevalence increased over time. Being employed (aPR=1.53 [95%CI=1.11–2.11]) was associated with higher anti-N prevalence, while a cancer history (aPR=0.40 [95%CI=0.17–0.90]) was associated with lower anti-N prevalence. HIV infection was associated with higher anti-S prevalence (aPR=1.13 [95%CI=1.02–1.27]), while younger age and experiencing homelessness (aPR=0.78 [95%CI=0.60–0.99]) were factors associated with lower anti-S prevalence. Substance use-related behaviors were not significantly associated with anti-N or anti-S prevalence. SARS-CoV-2 seroprevalence increased over time among current and former PWID, suggesting cumulative increases in the incidence of SARS-CoV-2 infection and vaccination; however, there were disparities in infection-induced seroprevalence and infection and/or vaccine-induced seroprevalence within this study sample. Dedicated prevention and vaccination programs are needed to prevent disparities in infection and gaps in population immunity among PWID during emerging epidemics.