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Observational Study
. 2025 Apr 10;25(1):531.
doi: 10.1186/s12913-025-12619-7.

Considerations for equitable distribution of digital healthcare for people who use drugs

Zoi Papalamprakopoulou  1   2 , Sotirios Roussos  3 , Elisavet Ntagianta  4 , Vasiliki Triantafyllou  4 , George Kalamitsis  4 , Arpan Dharia  1 , Vana Sypsa  3 , Angelos Hatzakis  2   3 , Andrew H Talal  5
Affiliations
Observational Study

Considerations for equitable distribution of digital healthcare for people who use drugs

Zoi Papalamprakopoulou et al. BMC Health Serv Res. .

Abstract

Background: Telehealth holds the potential to expand healthcare access for people who use drugs (PWUD). However, limited data exist on their digital infrastructure access, a prerequisite for telehealth participation. We studied digital healthcare accessibility among PWUD.

Methods: We employed respondent-driven sampling to recruit 162 PWUD in Athens, Greece to assess current internet and computer access and telemedicine experience via a structured questionnaire. Participants were at least 18 years with an injection drug use (IDU) history. We utilized logistic regression to evaluate sociodemographic associations.

Results: Participants' mean (SD) age was 45.9 (8.8) years, 84.0% were male, 90.1% Greek, 77.8% reported IDU within the past year, 85.2% were not linked to opioid treatment, and 50.0% were experiencing homelessness. Only 1.9% had telemedicine experience. Internet and computer access were reported by 66.0% and 31.5%, respectively. Most (77.9%) used mobile phones for internet access. Compared to participants with secure housing, those experiencing homelessness reported decreased internet (50.6% vs. 81.5%, p < 0.001) and computer access (11.1% vs. 51.9%, p < 0.001). Multivariable analyses revealed that older age (per 1-year increase: OR = 0.94, 95% CI [0.89, 0.99], p = 0.03)), IDU within the past year (0.29 [0.10, 0.88], p = 0.03), and homelessness (0.29, [0.13, 0.65], p = 0.003) were associated with lower odds of internet access.

Conclusions: Two-thirds of PWUD accessed the internet, mainly via mobile phones, while only one-third gained access through a computer. Very few PWUD used telemedicine. Homelessness, recent IDU, and older age may further limit digital infrastructure access and should be considered when designing equitable digital healthcare solutions for PWUD.

Trial registration: Registered on ClinicalTrials.gov (ID: NCT05794984, Protocol: STUDY00007088, Date: 2023-04-03).

Keywords: Digital healthcare; Health equity; Healthcare access; People who use drugs; Telehealth; Telemedicine.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study protocol was approved by the Institutional Review Boards of the Hellenic Scientific Society for the Study of AIDS, Sexually Transmitted and Emerging Diseases and the University at Buffalo. The study adhered to the Helsinki Declaration principles. We obtained written informed consent from all study eligible participants prior to their participation. Consent for publication: Not applicable. Competing interests: A.H.T. received grants from Merck, Gilead, and Abbott Laboratories and has served as an advisor at Gilead, Novo Nordisk, and AbbVie. VS has received grants from Gilead and AbbVie paid to affiliated institutions, and she has served as a lecturer for Gilead and AbbVie. The remaining authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Promotion of equitable digital healthcare distribution. Legend: People who use drugs (PWUD) are a medically underserved population who reported encountering geographical obstacles and stigma in accessing healthcare in conventional settings. Digital healthcare simultaneously overcomes geographical obstacles accompanied by a few empathy concerns. Therefore, the equitable distribution of digital healthcare services to PWUD is critical to avoid worsening future healthcare access. In our investigation, we found that homelessness, increasing age, and injection drug use within the past 12 months were associated with reduced internet and digital infrastructure access. We also identified gaps in digital literacy. To promote equitable distribution of digital healthcare, thereby ensuring health equity, requires expansion of internet and digital infrastructure access for underserved populations and addressing digital literacy gaps. Abbreviations: IDU, injection drug use.
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