Longitudinal examination of individual, social, and structural syndemics in drug overdose risk among people living with HIV (PLWH)
openNIDA - National Institute on Drug Abuse
PROJECT SUMMARY
The U.S. overdose crisis remains an urgent public health concern, with recent data demonstrating an increase
in fatal overdoses due to polydrug use with stimulants and opioids. People living with HIV (PLWH) are at
increased risk of drug-related overdose, with studies showing that HIV seropositivity increases overdose risk.
There is a gap in U.S.-based studies conducted in the past 5 years examining overdose trajectories and risk
factors among PLWH during the ongoing opioid crisis. Syndemics theory posits that the co-occurrence of two or
more health conditions (i.e., drug use and HIV) exacerbates the negative health effects of any or all health
conditions involved. Research examining syndemic risk factors for drug overdose among PLWH has been limited
to cross-sectional designs, has not measured access to overdose prevention services (e.g., naloxone,
medication for opioid use disorder; MOUD), or assessed risk factors across the socio-ecological model levels.
Further, there is a critical gap in examining trajectories of drug overdose risk and access to services among
PLWH during the most recent wave of the opioid crisis (2019-2025), characterized by polydrug use of stimulants
and opioids. This Substance Use Dissertation Research Award (R36) aims to develop a syndemics framework
to identify overdose risk factors among PLWH who use drugs across the levels of the socio-ecological model
(individual, social, and structural). This quantitative research study will address two research aims: (Aim 1) to
examine trajectories of overdose incidents, risk, and access to overdose prevention services (e.g., naloxone,
MOUD) among PLWH, and (Aim 2) to examine the influence of syndemic risk factors across the levels of the
socio-ecological model on trajectories of overdose incidents, risk, and access to overdose prevention services
among PLWH. Longitudinal, multilevel modelling will be used to estimate trajectories of self-reported overdose
incidents, polydrug use with psychostimulants and/or opioids, naloxone availability, and MOUD access over time
from 2019-2025 among PLWH in the CFAR Network of Integrated Clinical Systems (CNICS) database. Syndemic
risk factors at the individual-level (Hepatitis C co-infection, depression), social-level (intimate partner violence,
childhood trauma), and structural-level (housing instability, recent incarceration) will be included in the modelling
to identify how syndemic factors influence overdose risk among PLWH. This dissertation grant will contribute to
the applicant’s goal of an academic research career and will advance an innovative research program
investigating overdose risk among PLWH through a multisystemic lens. By adopting a transdisciplinary approach
and collaborating with experts in syndemics theory, multilevel modeling, and social science scholarship, this
research seeks to provide novel insights into the determinants of overdose risk among PLWH who use drugs.
Our ultimate goal is to develop a comprehensive syndemics framework that integrates the socioecological
perspective in identifying risk factors across the individual-, social-, and structural-levels. The outcomes of this
research will guide targeted interventions to reduce drug overdose among a high-risk, underserved population.
Up to $53K
health research