Dataset from Exploring Barriers and Facilitators to Women Who Use Drugs (WWUD) Awareness, Acceptance and Uptake of COVID-19 Testing (The CARE Study)

Background: The purpose of this study was to understand social, individual, and structural factors that influenced COVID-19 testing and retesting among women who use illicit drugs (WWUD), a group with high burdens of infectious, chronic, and pulmonary diseases. These health risks were shaped by persistent social conditions such as income scarcity, food insecurity, housing instability, discrimination, and limited access to services. These same conditions undermined the ability of WWUD to follow COVID-19 prevention measures. Given the importance of early testing and future vaccination, the study aimed to identify barriers, facilitators, and beliefs that shaped COVID-19 testing behaviors among WWUD in Baltimore.

Materials/Methods: The study used in-depth interviews with WWUD and a cultural domain analysis to examine predisposing social factors, individual-level behaviors, and beliefs related to COVID-19 testing and perceived risks associated with a diagnosis. Observations and key informant interviews with service providers were conducted to characterize the enabling community environment, including available medical and social services and existing COVID-19 testing sites. The study also followed a cohort of WWUD at baseline and at 3-month follow-up to assess associations between social factors, individual factors, medical mistrust, stigma, discrimination, and COVID-19 testing or retesting. Optional testing at both visits involved a self-administered rapid antigen test. A community advisory board guided study design, implementation, and dissemination.

Outcome/Impact: The study findings highlighted the influence of stigma and discrimination in healthcare settings, particularly among Black participants, and the long-standing mistrust associated with local medical institutions. Results informed community discussions and supported efforts to scale up accessible COVID-19 testing strategies for this high-risk population.