Awareness of and willingness to use pre-exposure prophylaxis (PrEP) among people who inject drugs and men who have sex with men in India: Results from a multi-city cross-sectional survey

Abstract

Introduction Pre-exposure prophylaxis (PrEP) is effective in reducing HIV transmission among key populations. In India, where PrEP is not currently part of the national HIV program, little is known about PrEP awareness, willingness to use PrEP, and barriers to uptake among people who inject drugs (PWID) and men who have sex with men (MSM). Methods We used respondent-driven sampling to accrue PWID and MSM in 22 sites from August 2016 to May 2017. Participants were asked about awareness of PrEP, willingness to use PrEP (following a brief description) and reasons why they might not be willing to use PrEP. Participants were also queried on preferences for PrEP delivery modality (oral vs. injectable). Multi-level logistic regression models were used to determine participant correlates of willingness to use PrEP. Estimates were weighted for the sampling method. Results A total of 10,538 PWID and 8,621 MSM who self-reported being HIV-negative were included in the analysis. Only 6.1% (95% confidence interval [CI]: 5.9, 6.3) of PWID and 8.0% of MSM (95% CI: 7.7, 8.4) were aware of PrEP. However, willingness to use PrEP was substantially higher in both groups: 52.4% of PWID and 67.6% of MSM. Participants commonly cited a perceived low risk for acquiring HIV infection, being perceived by others as being HIV-positive, and side effects as reasons why they would be unwilling to use PrEP. Among PWID, sharing needles and hazardous alcohol use were associated with increased willingness to use PrEP. Among MSM, having a main male partner and injection drug use were associated with increased willingness to use PrEP. Preference for daily oral or monthly injectable PrEP was similar among MSM (39.6%% vs. 41.7%,), while PWID were more likely to prefer oral to injectable administration routes (56.3% vs. 31.1%). Conclusions As India plans to roll-out of PrEP in the public sector, our multi-city survey of PWID and MSM highlights the need for key population-focused education campaigns about PrEP and self-assessment of risk.

HIV among people who inject drugs in India: a systematic review

“…Pre-exposure Prophylaxis (PrEP) has been recommended by WHO to be included in the HIV prevention package for PWID [ 69 ]. The Bangkok Tenofir Study [ 70 ] found daily oral Tenofir reduced the risk of HIV infection in PWID and considered PrEP with Tenofir for use as part of the HIV prevention package for PWID.…”

“…In India, the use of PrEP has been available in the private sector since 2016, however, PrEP has not been rolled out as part of a public sector National AIDS Control Program. However, a new national policy is underway to roll out PrEP as part of HIV combination prevention [ 69 ]. Belludi et al [ 69 ] highlight the need for key population-focused education and campaigns about PrEP and self-assessment of risk to link high-risk groups in PrEP programs.…”

“…However, a new national policy is underway to roll out PrEP as part of HIV combination prevention [ 69 ]. Belludi et al [ 69 ] highlight the need for key population-focused education and campaigns about PrEP and self-assessment of risk to link high-risk groups in PrEP programs. Future studies need to focus on the method of delivery and the effectiveness of PrEP in reducing the transmission of HIV among PWID in India.…”

Combating illicit fentanyl: Will increased Chinese regulation generate a public health crisis in India?

“…Most regions in India maintain punitive, rather than harm reducing, policies for people with drug dependence (90). The Ministry of Social Justice and Empowerment oversees the reduction of demand for illicit substances in India and should increase funding for opioid substitution therapy (OST), evidence-based treatment, fentanyl test strip and naloxone distribution (from healthcare facilities), pre-exposure prophylaxis (PrEP), which have been shown to reduce HIV transmission among drug users (91), safe needle exchange programs, and de-stigmatization drives. Young-adult male PWID in India have a heightened risk for needle sharing and sex with multiple partners, thus, tailored interventions uniquely targeting younger generations should be instituted (80), as younger and older generations of PWID may respond differently to different treatments.…”

A scoping review of lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) people’s health in India

“…Overall, 18 studies [176][177][178][179][180][181][182][183][184][185][186][187][188][189][190][191][192][193] (11 quantitative, 7 qualitative) focused on new HIV prevention technologies, including oral pre-exposure prophylaxis (PrEP) [176, 177, 182, 184, 187-190, 192, 193], future HIV vaccines [178][179][180][181]183] and rectal microbicides [185], as well as medical male circumcision [186], and oral HIV self-testing [191].…”