Longitudinal examination of individual, social, and structural syndemics in drug overdose risk among people living with HIV (PLWH) - 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.
