Preliminary indications of the burden of COVID-19 among people who inject drugs in England and Northern Ireland and the impact on access to health and harm reduction services

Objective: To describe the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on people who inject drugs (PWID) in England, Wales and Northern Ireland Study design: Cross-sectional unlinked anonymous monitoring (UAM) Survey of PWID Methods: People who had ever injected psychoactive drugs were recruited to the UAM Survey by specialist drug/alcohol services in England, Wales and Northern Ireland. From June 2020, in addition to providing a dried blood spot sample and completing the UAM behavioural questionnaire, participants were asked to complete an enhanced coronavirus disease (COVID-19) questionnaire. Preliminary data are presented to the end of October and were compared to data from the 2019 UAM Survey, where possible. Results: Between June and October, 288 PWID were recruited from England and Northern Ireland. One in nine (11%; 29/260) PWID reported testing positive for SARS-CoV-2 or experiencing COVID-19 symptoms. Fifteen percent (26/169) reported injecting more frequently in 2020 compared to 2019; cocaine injection in the preceding four weeks increased from 17% (242/1,456) to 25% (33/130). One in five PWID (22%; 35/188) reported difficulties in accessing HIV and hepatitis testing and one in four (26%; 47/179) reported difficulties in accessing equipment for safer injecting. Conclusions: Our preliminary findings suggest that PWID have experienced negative impacts on health, behaviours and access to essential harm reduction, testing and treatment services due to the COVID-19 pandemic. Continued monitoring through surveillance and research is needed to understand the subsequent impact of COVID-19 on blood-borne virus transmission in this population and on health inequalities