Project Grant R21DA057058

THE NON-FATAL OVERDOSE CRISIS: SEX AND GENDER DIFFERENCES IN HEALTHCARE UTILIZATION AND HEALTH OUTCOMES OF PEOPLE LIVING WITH AND WITHOUT HIV BETWEEN 2012 AND 2020 - PROJECT SUMMARY/ABSTRACT THE OVERDOSE (OD) CRISIS CONTINUES TO DEVASTATE COMMUNITIES ACROSS NORTH AMERICA. DESPITE 90% OF PARAMEDIC- ATTENDED ODS IN BRITISH COLUMBIA (BC), CANADA BEING NON-FATAL, MUCH OF THE RESEARCH HAS FOCUSED ON FATAL ODS. WHILE MEN ACCOUNT FOR OVER 70% OF FATAL ODS, THERE IS EVIDENCE OF A MORE BALANCED DISTRIBUTION OF MEN AND WOMEN EXPERIENCING NON-FATAL ODS (NFODS); FURTHER, WOMEN HAVE HIGHER MORTALITY RATES IN THE YEAR FOLLOWING AN NFOD. PEOPLE LIVING WITH HIV (PLHIV) ARE DISPROPORTIONATELY AFFECTED BY THE OD CRISIS AND ARE AT INCREASED RISK OF FATAL ODS, YET LITTLE IS KNOWN ABOUT THE LONGER-TERM IMPACTS OF NFODS ON PLHIV IN TERMS OF ADVERSE HEALTH OUTCOMES AND HEALTHCARE UTILIZATION (HCU). CONSIDERING THE INCREASINGLY HIGH RATES OF NFODS, GENDERED DIFFERENCES IN MORTALITY FOLLOWING AN NFOD, AND KNOWLEDGE GAPS CONCERNING HEALTH OUTCOMES FOLLOWING AN NFOD, THIS PROPOSAL SEEKS FUNDING TO INVESTIGATE THE ROLE OF SEX, GENDER, AND HIV STATUS IN DIFFERENTIAL NFOD OUTCOMES. BC'S UNIVERSAL HEALTHCARE SYSTEM AND DATA CENTRALIZATION ENABLED THE COMPARATIVE OUTCOMES AND SERVICE UTILIZATION TRENDS (COAST) STUDY, A POPULATION-BASED LONGITUDINAL COHORT COMPRISED OF LINKED ADMINISTRATIVE HEALTH DATASETS ON ALL KNOWN ADULT PLHIV AND A 10% RANDOM SAMPLE OF THE GENERAL POPULATION IN BC. USING COAST, WE AIM TO: (1) GENERATE ESTIMATES FOR THE INCIDENCE RATES OF FATAL AND NONFATAL ODS AMONG PEOPLE LIVING WITH AND WITHOUT HIV (2012-2020) IN BC; (2) ASSESS AND COMPARE CHANGES IN HEALTH CARE UTILIZATION, CHRONIC COMORBIDITY, AND MORTALITY AMONG PEOPLE LIVING WITH AND WITHOUT HIV WHO EXPERIENCED AN NFOD, MODIFIED BY SEX AND GENDER; AND (3) ASSESS AND COMPARE CHANGES IN HIV TREATMENT OUTCOMES IN PEOPLE LIVING WITH HIV WHO EXPERIENCED AN NFOD, MODIFIED BY SEX AND GENDER. THIS PROJECT WILL ALSO INVOLVE THE DEVELOPMENT OF A COMMUNITY ADVISORY BOARD (CAB) FOR PROPOSED AND FUTURE PROJECTS. THE CAB WILL PROVIDE GUIDANCE TO ENSURE RESEARCH SOUNDNESS AND RELEVANCE TO THE COMMUNITY THROUGHOUT THE RESEARCH AND KNOWLEDGE MOBILIZATION PROCESSES. OUR COLLABORATIVE RESEARCH WILL BE AN OPPORTUNITY TO EXPLORE OTHER RESEARCH POSSIBILITIES INITIATED BY THE CAB AS IMPORTANT FOR WOMEN AND GENDER MINORITIES LIVING WITH AND WITHOUT HIV WHO ARE AFFECTED BY THE OD CRISIS. IN RESPONSE TO THE NATIONAL INSTITUTE ON DRUG ABUSE NOTICE OF SPECIAL INTEREST NOT-DA- 21-021 TO ADVANCE RESEARCH SPECIFIC TO WOMEN AND OTHER UNDERREPRESENTED POPULATIONS INCLUDING GENDER MINORITIES, THIS PROPOSAL WILL INFORM FUTURE CAB-LED CYCLES OF INQUIRY AND ANALYSIS AMONGST OUR TEAM TO ANSWER RELEVANT RESEARCH QUESTIONS AND ADDRESS THE IDENTIFIED NEEDS OF CISGENDER WOMEN AND GENDER MINORITIES LIVING WITH AND WITHOUT HIV AFFECTED BY THE OD CRISIS.