A Capacity-Strengthening Intervention to Support HIV Pre-exposure Prophylaxis (PrEP) Awareness-Building and Promotion by Frontline Harm Reduction Workers in Baltimore, Maryland: A Mixed Methods Evaluation

Abstract

Pre-exposure prophylaxis (PrEP) is a promising but underutilized HIV prevention tool among people who inject drugs (PWID). We developed and piloted an intervention to bolster PrEP promotion competencies among frontline harm reduction workers (FHRW) serving PWID clients in Baltimore, Maryland. Between December 2021 and February 2022, we developed and facilitated four trainings, which included didactic and practice-based/role-playing components, with 37 FHRW from four organizations. FHRW completed three structured surveys (pretest, posttest, 6-week posttest) and in-depth interviews ( n = 14) to measure changes in PrEP promotion competencies attributable to training participation. PrEP knowledge and self-efficacy increased significantly ( p < 0.001) from pretest to posttest, sustained through 6-week posttest. The proportion of FHRW discussing PrEP with clients doubled during the evaluation period (30–67%, p = 0.006). Feeling empowered to discuss PrEP and provision of population-tailored PrEP information were facilitators of PrEP promotion, while limited client interaction frequency/duration, privacy/confidentiality concerns, and anticipated PrEP stigma by clients inhibited PrEP promotion. Our capacity-strengthening intervention successfully increased PrEP knowledge, self-efficacy, and promotion among FHRW, affirming the adaptability and feasibility of integrating our training toolkit into FHRW practice across implementation settings. Supplementary Information The online version contains supplementary material available at 10.1007/s10461-022-03971-4.

HIV pre‐exposure prophylaxis champion preceptorship training for pharmacists and nurses in the United States

“…Finally, another study that combined fictional client personas, role-play exercises, and focused on providing information on PrEP effectiveness, prescribing practices, and service delivery, demonstrated increased PrEP knowledge and self-efficacy among Baltimore HIV clinicians. 19 Similarly, the evaluation of our training showed improvements in learners' knowledge, comfort, skills, and capacity to provide PrEP, as well as scalability of PrEP provision posttraining.…”

“…Trainees were less likely to express frustration with challenging cases and reported more confidence in sexual history taking, improved skills in assessing readiness for change, and increased support in their clinical setting. Finally, another study that combined fictional client personas, role‐play exercises, and focused on providing information on PrEP effectiveness, prescribing practices, and service delivery, demonstrated increased PrEP knowledge and self‐efficacy among Baltimore HIV clinicians 19 . Similarly, the evaluation of our training showed improvements in learners' knowledge, comfort, skills, and capacity to provide PrEP, as well as scalability of PrEP provision posttraining.…”

“Take services to the people”: strategies to optimize uptake of PrEP and harm reduction services among people who inject drugs in Uganda

“…Other studies have also identified limited PrEP awareness or inaccurate information on PrEP among PWID [34][35][36][37][38]. To improve awareness, one study leveraged existing rapport with harm reduction providers to improve accuracy of PrEP knowledge among PWID [35].…”

The use of oral HIV pre-exposure prophylaxis among people who inject drugs: barriers, and recommendations

“…To improve PrEP knowledge among PWID, we recommend educational programs that target them. These programs should include the dissemination of PrEP education in various media platforms such as social and mass media, as well as information leaflets and billboards ( 22 ). HCWs should provide PrEP knowledge to PWID when they are being attended for other health problems, including drug addiction rehabilitation services ( 23 ).…”

“…HCWs should provide PrEP knowledge to PWID when they are being attended for other health problems, including drug addiction rehabilitation services ( 23 ). PrEP education programs should also involve peer educators, especially those who have been successfully rehabilitated since they may be trusted by PWID ( 22 ). We recommend that the provision of PrEP knowledge should include information about the common side effects of oral PrEP, as well as address the misconceptions and myths about oral PrEP.…”