Delivering Preexposure Prophylaxis to People Who Use Drugs and Experience Homelessness, Boston, MA, 2018–2020

Biello, Katie B.; Bazzi, Angela R.; Vahey, Seamus; Harris, Miriam; Shaw, Leah; Brody, Jennifer K

doi:10.2105/ajph.2021.306208

Cited by 17 publications

(7 citation statements)

References 6 publications

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“…Ongoing HIV transmission among PWID experiencing homelessness led BHCHP to develop a low-threshold program to increase PrEP access for their patient population [5]. Using data from qualitative interviews with a sample of BHCHP PrEP program participants [6], we conducted an initial exploration of the social experiences surrounding PrEP use among PWID experiencing homelessness.…”

Section: Discussionmentioning

confidence: 99%

“…Amidst ongoing HIV transmission among PWID, Boston Health Care for the Homeless Program (BHCHP) implemented an innovative PrEP program for PWID experiencing homelessness. An evaluation of patient medical records from this program, which involves tailored PrEP education, patient navigation, same-day PrEP prescribing, short-term prescriptions, medication storage, and intensive adherence supports including street-based daily medication dosing, suggested that it effectively increased PrEP uptake and persistence [5]. To assess the acceptability of key components of this program, we conducted qualitative interviews exploring patients' experiences with the program and PrEP use more generally [6].…”

Section: Introductionmentioning

confidence: 99%

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PrEP disclosure and discussions within social networks of people who inject drugs experiencing homelessness: a brief report

et al. 2023

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Background In the context of increasing injection-related HIV outbreaks across the United States, particularly among people who inject drugs (PWID) experiencing homelessness, there is an urgent need to expand access to pre-exposure prophylaxis (PrEP) for HIV prevention. Peer-based interventions for PrEP could be helpful for promoting PrEP uptake, yet the social experiences of using PrEP among PWID experiencing homelessness have not been thoroughly explored. Methods To better understand social experiences surrounding PrEP use among PWID experiencing homelessness, we conducted qualitative interviews from March-December 2020 with current and former PrEP patients of an innovative, low-threshold program implemented by Boston Health Care for the Homeless Program (BHCHP) in Boston, MA. Thematic analysis of coded interview data explored participants’ perspectives and experiences with PrEP disclosure and discussions within their social networks. Results Among interviews with 21 participants, we identified the following four interrelated aspects of their social experiences using PrEP: (1) participants’ were aware of increasing HIV transmission within their social networks, which motivated their PrEP use and disclosure; (2) participants generally avoided disclosing their PrEP use within public spaces or casual conversations; (3) participants expressed greater willingness to discuss PrEP with their close social contacts; and (4) some participants self-identified as leaders or expressed interest in leading the dissemination of PrEP information within their social networks. Conclusions Findings highlight the significance of PrEP disclosure and discussions within the social networks of PWID experiencing homelessness, suggesting a need for continued social network and intervention research—particularly to establish the feasibility and acceptability of peer-based interventions for promoting PrEP—with this marginalized population.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

PrEP disclosure and discussions within social networks of people who inject drugs experiencing homelessness: a brief report

et al. 2023

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“…Low-barrier, walk-in sites are often acceptable alternatives to appointment-only, office-based services and have proven successful in providing primary care to PWID in Seattle [44,45]. Opportunities for examining daily, oral PrEP adherence support lie in the success of offering HCV treatment and SUD medications to PWID in a directly observed therapy setting such as opioid treatment program and in replicating those models addressed earlier in the manuscript [46][47][48]. Of note PrEP medications are clinically safe to take along with OUD treatments (e.g., buprenorphine and methadone) [49].…”

Section: Discussionmentioning

confidence: 99%

Qualitative inquiry into perceptions of HIV pre-exposure prophylaxis among people who inject drugs living with hepatitis C in Seattle, WA, USA

et al. 2022

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Background The incidence of HIV among persons who inject drugs (PWID) in the USA has been increasing since 2014, signaling the need to identify effective ways to engage PWID in HIV prevention services, namely pre-exposure prophylaxis (PrEP). Yet, the uptake of PrEP in this population is minimal compared to other populations at risk of HIV acquisition. In this work, we sought to explore knowledge, attitudes, and perspectives of PrEP acceptability among PWID. Methods In the context of a pilot study to explore the acceptability of pharmacy-based hepatitis C virus (HCV) treatment, we conducted semi-structured interviews (n = 24) and focus groups (n = 4, 16 participants) with people who were living with HCV and reported active injection drug use (≤ 90 days since last use). Participants were asked open-ended questions about their familiarity with and motivation to use PrEP. As part of a sub-analysis focused on PrEP, qualitative data were analyzed using a Rapid Assessment Process, where three coders used structured templates to summarize qualitative data and iteratively reviewed coded templates to identify themes. Participants also completed short quantitative questionnaires regarding drug use history and attitudes toward health concerns. Results Forty-seven percent of participants expressed having little or no concern regarding HIV acquisition. Targeted analyses focused on HIV prevention identified three themes, which help characterize behavioral determinants of nonadoption. First, knowledge of PrEP was limited among PWID and influenced by infrequent open community discussions around HIV risk. Second, PWID perceived sexual behaviors—but not injection drug use—as a motivator for HIV risk prevention. Finally, PWID identified many individual and environmental barriers that hinder PrEP uptake. Conclusion Among PWID, PrEP is rarely discussed and concerns about the feasibility of using daily PrEP are common. Taken with the prevalent perception that drug use is not a high risk for HIV acquisition, our findings point to opportunities for public health work to target PrEP education to PWID and to leverage other successful interventions for PWID as an opportunity to provide PrEP to this vulnerable population.

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“…This finding is supported by the literature, which shows that PrEP knowledge among persons experiencing homelessness is extremely low, especially in the U.S. South. To our knowledge, there are just two published studies on providing PrEP services to persons experiencing homelessness ( Biello et al, 2021 ; Gregg et al, 2020 ). Thus, future iterations of AH3 will also focus on expanding PrEP care to persons experiencing homelessness.…”

Section: Implications For Practicementioning

confidence: 99%

Addressing HIV and Homelessness During COVID-19: A Community-Based Demonstration Project

Kay

Bruce

Foster-Hill

et al. 2022

Health Promotion Practice

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People experiencing homelessness are at increased risk for HIV, and people with HIV (PWH) experiencing homelessness are more likely to experience suboptimal HIV health outcomes than PWH with stable housing. Within Alabama, a state prioritized in the Ending the HIV Epidemic initiative, Jefferson County consistently has the highest number of new HIV diagnoses as well as a high percentage of the state’s homeless population. To address the twin epidemics of both HIV and homelessness within the high-priority setting of Jefferson County, Alabama, this 1-year community-based project, Ending the HIV Epidemic: Addressing HIV Health and Homelessness (AH3), sought to increase HIV testing and linkage to care among this population by placing a full-time case manager trained in HIV testing and case management at a homeless shelter. Results demonstrated that HIV testing was highly acceptable: 733 individuals were offered a test, and only 2.7% (n = 20) declined. Nine previously diagnosed, out of care PWH and one newly diagnosed PWH were identified through AH3 testing efforts. Of these, five (50%) were linked to care at a local HIV clinic. The remaining five PWH left the shelter before they could be linked to care. Just 10 shelter guests expressed interest in taking PrEP (just 1.4% of guests who tested negative for HIV), and only one of these linked to PrEP care. Future health promotion programs are needed to address mental health and other ancillary needs among this population, as well as programs that provide access to PrEP and other HIV prevention services.

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Delivering Preexposure Prophylaxis to People Who Use Drugs and Experience Homelessness, Boston, MA, 2018–2020

Cited by 17 publications

References 6 publications

PrEP disclosure and discussions within social networks of people who inject drugs experiencing homelessness: a brief report

PrEP disclosure and discussions within social networks of people who inject drugs experiencing homelessness: a brief report

Qualitative inquiry into perceptions of HIV pre-exposure prophylaxis among people who inject drugs living with hepatitis C in Seattle, WA, USA

Addressing HIV and Homelessness During COVID-19: A Community-Based Demonstration Project

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