Injection drug use, food insecurity, and HIV-HCV co-infection: a longitudinal cohort analysis

ABSTRACT

Injection drug use (IDU) and food insecurity (FI) are highly prevalent among individuals living with HIV-hepatitis C virus (HCV) co-infection. We quantified the association between IDU and FI among co-infected individuals using biannual data from the Canadian Co-infection Cohort (N = 608, 2012–2015). IDU (in the past six months) and IDU frequency (non-weekly/weekly in the past month) were self-reported. FI (in the past six months) and FI severity (marginal FI, moderate FI, and severe FI) were measured using the Household Food Security Survey Module. Generalized estimating equations were used to estimate risk ratios (RR) quantifying the associations between IDU, IDU frequency, and FI with Poisson regression. The associations between IDU, IDU frequency, and FI severity were quantified by relative-risk ratios (RRR) estimated with multinomial regression. At the first time-point in the analytical sample, 54% of participants experienced FI in the past six months, 31% engaged in IDU in the six months preceding the FI measure, and 24% injected drugs in the past month. After adjustment for confounding, IDU in the past six months (RR = 1.15, 95% confidence interval [CI] = 1.04–1.28) as well as non-weekly (RR = 1.15, 95% CI = 1.02–1.29) and weekly IDU (RR = 1.21, 95% CI = 1.07–1.37) in the past month are associated with FI. Weekly IDU in the past month is also strongly associated with severe FI (RRR = 2.68, 95% CI = 1.47–4.91). Our findings indicate that there is an association between IDU and FI, particularly weekly IDU and severe FI. This suggests that reductions in IDU may mitigate FI, especially severe FI, in this vulnerable subset of the HIV-positive population.

KEYWORDS:

• HIV
• hepatitis C virus
• injection drug use
• food insecurity

Acknowledgements

TM is supported by a CANOC Centre Doctoral Scholarship Award, a joint program of CANOC and the CIHR Canadian HIV Trials Network (CTN 242). EEMM is supported by a Chercheur-Boursier (Senior) Career Award from the Fonds de recherche du Quebec-Sante (FRQ-S). MBK is supported by a Chercheurs Nationaux Career Award from the FRQ-S.

The authors thank Jennifer Kocilowicz and Leo Wong for study coordination. The Canadian Co-infection Cohort investigators (CTN 222) are: Drs. Jeff Cohen (Windsor Regional Hospital Metropolitan Campus, Windsor, ON), Brian Conway (PENDER Downtown Infectious Diseases Clinic, Vancouver, BC), Curtis Cooper (The Ottawa Hospital Research Institute, Ottawa, ON), Pierre Côté (Clinique du Quartier Latin, Montreal, QC), Joseph Cox (McGill University Health Centre, Montreal, QC), John Gill (Southern Alberta HIV Clinic, Calgary, AB), Shariq Haider (McMaster University Medical Centre – SIS Clinic, Hamilton, ON), Aida Sadr (Native BC Health Center, St Paul's Hospital, Vancouver, BC), Lynn Johnston (QEII Health Science Center for Clinical Research, Halifax, NS), Mark Hull (BC Centre for Excellence in HIV/AIDS, Vancouver, BC), Julio Montaner (St Paul's Hospital, Vancouver, BC), Erica Moodie (McGill University, Montreal, QC), Neora Pick (Oak Tree Clinic, Children's and Women's Health Centre of British Columbia, University of British Columbia, Vancouver, BC), Anita Rachlis (Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON), Danielle Rouleau (Centre Hospitalier de l’Université de Montreal, Montreal, QC), Roger Sandre (Health Sciences North – The HAVEN/Hemophilia Program, Sudbury, ON), Joseph Mark Tyndall (Department of Medicine, Infectious Diseases Division, University of Ottawa, Ottawa ON), Marie-Louise Vachon (Centre Hospitalier Universitaire de Québec, Québec, QC), Steve Sanche (SHARE University of Saskatchewan, Saskatoon, SK), Stewart Skinner (Royal University Hospital & Westside Community Clinic, University of Saskatchewan, Saskatoon, SK), and David Wong (University Health Network, Toronto, ON).

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was funded by the Canadian Institutes of Health Research [CIHR, MOP-79529] and the CIHR Canadian HIV Trials Network [CTN 264 & CTN 222].