Exploring barriers and facilitators to women who use drugs (WWUD) awareness, acceptance and uptake of COVID-19 testing, the CARE study.

Project Summary In the U.S. women who use illicit drugs (WWUD) have disproportionately high rates of infectious(e.g., HIV, HCV), chronic, and pulmonary diseases that elevate their risk for COVID-19. Their health anddisease profile is driven by enduring social conditions (e.g., scarcity of income, food insecurity, access tohealth services, housing, discrimination). These prevailing social conditions can also undermine WWUDs'ability to protect themselves from COVID-19 (e.g., washing hands, social distancing). Drug procurementand use, which are largely social processes, further challenge these self-protection measures. Testingand future vaccination is vital to reducing COVID-19 among this high-risk population, necessitatingaccessible testing schemes. We propose a mixed methods study that draws upon the AndersenBehavioral Model10 and is grounded in eco-social theory. Specifically, the Baltimore-based study aims to:1) explore predisposing social factors (e.g., housing, food security), individual-level factors (e.g., drug use,mental health), and beliefs (e.g., medical mistrust) that are facilitators and barriers of COVID-19 testingand perceived risks (e.g., income generation, violence) resulting from a diagnosis through in-depthinterviews among WWUD (N=15) and a cultural domain analysis (N=45); 2) gain an understanding of theenabling community-level environment (e.g., medical and social service agencies that currently serveWWUD, existing city-wide COVID-19 testing sites) that could facilitate or hinder WWUDs' COVID-testinguptake through observations (N=8-10) and key informant interviews (N=10); and examine predisposingsocial factors, individual-level factors, and beliefs that are associated with COVID-19 testing and retestingamong a cohort (N=250) of WWUD at baseline and 3-month follow-up. Optional testing offered at bothstudy visits will be a self-administered, rapid antigen test. We will also examine the role of medicalmistrust in shaping women's use of healthcare services as well as experiences of stigma anddiscrimination in healthcare settings, particularly among Black participants. In Baltimore, this mistrust isparticularly pronounced, with Johns Hopkins Hospital having a long history of mistrust in the Blackcommunity owing to experimentation and deception of research engagement. The study will be guided bya community advisory board (CAB) who will inform its design and implementation as well as engage indisseminating the results at community meetings to inform COVID-testing scale up.