Benefit of a sustained community-based psychiatric intervention for people who inject drugs (DRIVE-Mind 2 project).

Background

In LMIC, access to psychiatric care for PWID in the standard mental health system is limited due to low resources, stigma and cost of the treatments/consultations. The aim of this survey is to show that PWID who initially had depression, psychotic syndrome and/or a suicide risk and who receive an alternative sustained community-based psychiatric intervention, are comparable in terms of HIV/HCV exposure risk, severity of substance use and quality of life with PWID free of psychiatric disorder.

Methods

PWID previously engaged in psychiatric care for 3 years (DRIVE-Mind 1 cohort) or currently diagnosed with a mental health problem were proposed to be recruited in a one-year follow-up psychiatric cohort, and to be compared to PWID controls. Psychiatric intervention included free psychiatric care in a community-based setting with full support of trained peers and consultations on site from psychiatrists from the mental health department. Controls developing mental health problems during the one-year follow-up period were removed from the data analysis. PWID from the psychiatric cohort were then compared to controls for HIV/HCV exposure (composite score), severity of substance use (heroin injection, daily injection, frequent methamphetamine use, polysubstance use) and quality of life (EQ5D5L).

Results

Altogether, 563 PWID were enrolled, 185 in the psychiatric cohort (129 from the DRIVE-Mind 1 cohort, symptomatic or not, and 56 newly diagnosed with a mental health problem) and 378 controls. 412 PWID attended the month 12 visit, including 256 controls and 159 PWID from the psychiatric cohort.

PWID from the psychiatric cohort did not differ from controls in terms of viral exposure and severity of substance use. Regarding quality of life, they still differed for several components of the EQ5D5L. Moreover, PWID from the psychiatric cohort were still less often treated with methadone than controls and had less often regular resources, depending more often from family income.

Conclusions

Sustained community-based psychiatric follow-up allowed to make comparable PWID suffering from psychiatric disorders to controls in terms of drug use and risk behaviors. It partly improved their quality of life and failed to improve their access to methadone, probably due to lower resources in this population. Comprehensive approach for PWID suffering from psychiatric disorder should include free access to methadone treatment.