Background The COVID-19 pandemic may have disproportionally impacted vulnerable groups such as people who inject drugs (PWID) through reduced healthcare services as well as social changes from pandemic mitigation measures. Understanding how the COVID-19 pandemic and associated mitigation strategies subsequently changed the trajectory of hepatitis C virus (HCV) and HIV transmission is critical to estimating disease burdens, identifying outbreak risk, and developing informed intervention strategies. Methods Using behavioral data from the AIDS Linked to the IntraVenous Experience (ALIVE) study, an ongoing community-based cohort of PWID in Baltimore, USA, and an individual-based network model, we explored the impacts of service disruptions combined with changes in social networks and injecting behaviors of PWID on HCV and HIV transmission. Results Analyses of ALIVE data showed that during the pandemic, there was an acceleration in injection cessation trajectories overall, but those who continued injecting increased the frequency of injection; at the same time, individual drug-use networks became smaller and the probability of injecting with others decreased. Simulation results demonstrated that HCV and HIV prevalence increased from service disruptions alone, but these effects were mitigated when including observed behavior changes in addition. Conclusions Model results combined with rich individual behavioral data indicated that pandemic-induced behavioral changes of PWID that lasted longer than service disruptions could have offset the increasing disease burden caused by disrupted service access during the pandemic.

中文翻译：

---

大流行引起的服务中断和行为变化对注射吸毒者中 HCV 和 HIV 传播的影响：一项建模研究


背景COVID-19 大流行可能通过减少医疗保健服务以及大流行缓解措施带来的社会变化，对注射吸毒者 （PWID） 等弱势群体产生了不成比例的影响。了解 COVID-19 大流行和相关缓解策略随后如何改变丙型肝炎病毒 （HCV） 和 HIV 传播的轨迹，对于估计疾病负担、识别疫情风险和制定明智的干预策略至关重要。方法使用来自与静脉内体验相关的艾滋病 （ALIVE） 研究的行为数据，美国巴尔的摩正在进行的基于社区的 PWID 队列，以及基于个人的网络模型，我们探讨了服务中断与社交网络变化和注射行为的影响 注射 PWID 对 HCV 和 HIV 传播。结果 对 ALIVE 数据的分析显示，在大流行期间，整体停针轨迹加速，但继续注射的人增加了注射频率;同时，个体药物使用网络变得更小，与他人注射的可能性降低。模拟结果表明，仅因服务中断而增加 HCV 和 HIV 患病率，但当包括观察到的行为变化时，这些影响得到了缓解。结论 模型结果结合丰富的个体行为数据表明，大流行引起的 PWID 行为变化持续时间超过服务中断时间，可能抵消了大流行期间服务访问中断造成的日益增加的疾病负担。