BACKGROUND: Personal protective measures help prevent infection and disease transmission during health crises such as Coronavirus disease 2019 (COVID-19). Populations facing barriers to adhering to these measures are more vulnerable to the health crisis. This study investigated the association of social drivers of health (SDoH), self-efficacy, and adverse substance use behavior changes with ability to practice COVID-19 personal protective behaviors among persons who inject drugs (PWID) with hepatitis C virus (HCV) infection history.

METHODS: This study used the Hepatitis C Real Options (HERO) study's COVID-19 survey data ( = 157). The association of inability to practice COVID-19 personal protective behaviors (hand washing, social distancing, etc.) with (a) SDoH difficulties (employment, housing, etc.); (b) adverse substance use behavior change (overdose, injecting behavior, etc.); and (c) self-efficacy was tested using logistic regression.

RESULTS: Inability to practice any personal protective behaviors was more likely among those experiencing any vs. no SDoH difficulties [adjusted odds ratio () (95% confidence interval ())] = 4.57 (1.57, 16.40); = 0.003] but less likely for those with higher overall self-efficacy [ (95% ) = 0.55 (0.32, 0.93); = 0.025] and self-efficacy for setting goals [ (95% ) = 0.63 (0.40, 0.96); = 0.031]. The association between adverse substance use behavior changes and the outcome was not significant.

CONCLUSIONS: Greater SDoH difficulties and lower self-efficacy were associated with greater inability to practice COVID-19 personal protective behaviors. Interventions to meet SDoH-related challenges and increase self-efficacy could help encourage practice of personal protective behaviors and economically reduce disease burden during health crises.