Charles Marks1, Zachary Bouck2, Sonia Jain3, Xiaoying Sun3, Steffanie A Strathdee4, Peter Vickerman5, Kora DeBeck6, M-J Milloy7, Kanna Hayashi8, Dan Werb9. 1. Joint Doctoral Program in Interdisciplinary Research on Substance Use, San Diego State University and University of California, San Diego, United States. 2. Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. 3. Biostatistics Research Center, Department of Family Medicine and Public Health, University of California San Diego, San Diego, United States. 4. Division of Infectious Diseases & Global Public Health, University of California, San Diego, United States. 5. Population Health Sciences, University of Bristol, Bristol, UK. 6. School of Public Policy, Simon Fraser University, Vancouver, Canada; British Columbia Centre on Substance Use, Vancouver, Canada. 7. British Columbia Centre on Substance Use, Vancouver, Canada; Department of Medicine, University of British Columbia, Vancouver, Canada. 8. British Columbia Centre on Substance Use, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada. 9. Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Division of Infectious Diseases & Global Public Health, University of California, San Diego, United States; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. Electronic address: dwerb@health.ucsd.edu.
Abstract
OBJECTIVE: To assess the relationship between experiencing homelessness and assisting injection drug use (IDU) initiation among people who inject drugs (PWID) in Tijuana, Mexico and Vancouver, Canada. METHODS: We used self-reported questionnaire data collected semi-annually on PWID from Tijuana (n = 703) and Vancouver (n = 1551) between 2014 and 2017. Within each setting, the effect of recent (i.e., past six months) homelessness on recent provision of injection initiation assistance (i.e., helping anybody inject for the first time in the past six months) was estimated using inverse-probability-of-treatment (IPT)-weighted estimation of a marginal structural model. RESULTS: Across follow-up, the prevalence of recent homelessness at a given visit ranged from 11.6%-16.5% among Tijuana-based participants and 9.4%-18.9% among Vancouver-based participants; the prevalence of recent provision of injection initiation at a given follow-up visit was lower, ranging from 3.3%-5.4% in Tijuana and 2.5%-4.1% in Vancouver. Based on the IPT-weighted estimates, recent homelessness was associated with 66% greater odds among Tijuana-based PWID (Adjusted Odds Ratio [AOR] = 1.66; 95% CI: 1.01-2.73) and 47% greater odds among Vancouver-based PWID (AOR = 1.47, 95% CI: 1.02-2.13) of providing injection initiation assistance over the same six-month period. CONCLUSION: We found that recently experiencing homelessness was associated with an increased likelihood of PWID reporting IDU initiation assistance over time in both Tijuana and Vancouver. Addressing homelessness may decrease the initiation of IDU via multiple pathways.
OBJECTIVE: To assess the relationship between experiencing homelessness and assisting injection drug use (IDU) initiation among people who inject drugs (PWID) in Tijuana, Mexico and Vancouver, Canada. METHODS: We used self-reported questionnaire data collected semi-annually on PWID from Tijuana (n = 703) and Vancouver (n = 1551) between 2014 and 2017. Within each setting, the effect of recent (i.e., past six months) homelessness on recent provision of injection initiation assistance (i.e., helping anybody inject for the first time in the past six months) was estimated using inverse-probability-of-treatment (IPT)-weighted estimation of a marginal structural model. RESULTS: Across follow-up, the prevalence of recent homelessness at a given visit ranged from 11.6%-16.5% among Tijuana-based participants and 9.4%-18.9% among Vancouver-based participants; the prevalence of recent provision of injection initiation at a given follow-up visit was lower, ranging from 3.3%-5.4% in Tijuana and 2.5%-4.1% in Vancouver. Based on the IPT-weighted estimates, recent homelessness was associated with 66% greater odds among Tijuana-based PWID (Adjusted Odds Ratio [AOR] = 1.66; 95% CI: 1.01-2.73) and 47% greater odds among Vancouver-based PWID (AOR = 1.47, 95% CI: 1.02-2.13) of providing injection initiation assistance over the same six-month period. CONCLUSION: We found that recently experiencing homelessness was associated with an increased likelihood of PWID reporting IDU initiation assistance over time in both Tijuana and Vancouver. Addressing homelessness may decrease the initiation of IDU via multiple pathways.
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