The Past, Present, and Future of PrEP implementation Among People Who Use Drugs

Biello, Katie B.; Mimiaga, Matthew J.; Valente, Pablo K.; Saxena, Nimish; Bazzi, Angela R.

doi:10.1007/s11904-021-00556-z

Cited by 32 publications

(17 citation statements)

References 113 publications

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“…In the context of ongoing HIV transmission among PWID experiencing homelessness across the USA, 2 programmatic innovations are needed to expand access to effective HIV prevention options for this population. 39 , 53 Most PrEP research with PWID has been with individuals lacking PrEP experience, and beyond research contexts, 54 very few real-world programs have been investigated. 40 , 43 From interviews with PrEP patients and providers involved with a novel program for PWID experiencing homelessness in Boston, MA, we identified key program components that were perceived to be acceptable, feasible, and supportive of patients’ success.…”

Section: Discussionmentioning

confidence: 99%

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Patient and Provider Perspectives on a Novel, Low-Threshold HIV PrEP Program for People Who Inject Drugs Experiencing Homelessness

et al. 2022

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Background HIV outbreaks among people who inject drugs (PWID) and experience homelessness are increasing across the USA. Despite high levels of need, multilevel barriers to accessing antiretroviral pre-exposure prophylaxis (PrEP) for HIV prevention persist for this population. The Boston Health Care for the Homeless Program (BHCHP) initiated a low-threshold, outreach-based program to support engagement in PrEP services among PWID experiencing homelessness. Methods To inform dissemination efforts, we explored patient and provider perspectives on key program components. From March to December 2020, we conducted semi-structured qualitative interviews with current and former BHCHP PrEP program participants and prescribers, patient navigators, and outreach workers (i.e., providers). Thematic analysis explored perspectives on key program components. Results Participants (n = 21) and providers (n = 11) identified the following five key components of BHCHP’s PrEP program that they perceived to be particularly helpful for supporting patient engagement in PrEP services: (1) community-driven PrEP education; (2) low-threshold, accessible programming including same-day PrEP prescribing; (3) tailored prescribing supports (e.g., on-site pharmacy, short-term prescriptions, medication storage); (4) intensive outreach and navigation; and (5) trusting, respectful patient-provider relationships. Discussion Findings suggest that more patient-centered services formed the basis of BHCHP’s innovative, successful PrEP program. While contextual challenges including competing public health emergencies and homeless encampment “sweeps” necessitate ongoing programmatic adaptations, lessons from BHCHP’s PrEP program can inform PrEP delivery in a range of community-based settings serving this population, including syringe service programs and shelters.

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Section: Discussionmentioning

confidence: 99%

“… 15 , 23 , 37 , 38 Improved PrEP programming for PWID—and dissemination of strategies that are feasible, acceptable, and effective—is clearly needed. 39 …”

Section: Introductionmentioning

confidence: 99%

Patient and Provider Perspectives on a Novel, Low-Threshold HIV PrEP Program for People Who Inject Drugs Experiencing Homelessness

et al. 2022

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“…12 The underutilization of PrEP can be partially explained by clinicians who work with PWIDs and serve as gatekeepers due to implicit or explicit anti-PWID biases. 13 We define implicit bias as negative attitudes or stereotypes that affect clinicians' interactions, decisions, and actions toward PWID in an unconscious manner. 14 Explicit bias, in turn, refers to conscious negative attitudes, often represented by discrimination and prejudice against PWID.…”

Section: Introductionmentioning

confidence: 99%

Provider Implicit Bias in Prescribing HIV Pre-exposure Prophylaxis (PrEP) to People Who Inject Drugs

et al. 2023

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Background Multiple HIV outbreaks among people who inject drugs (PWIDs) have occurred in the USA since 2015, highlighting the need for additional HIV prevention tools. Despite high levels of need, pre-exposure prophylaxis (PrEP) is drastically underutilized among PWIDs. Implicit bias toward PWID held by clinicians may impede PrEP scale-up among these underserved patients. This study examined how primary care providers’ (PCPs) clinical decisions related to PrEP can be impacted by biases when the patient has a history of substance use. Methods We conducted an online survey of PCPs (n = 208). The survey included the implicit association test (IAT) to assess unconscious attitudes toward PWIDs, direct questions regarding clinicians’ explicit PWID attitudes, and an embedded experiment in which we systematically varied the risk behavior of a hypothetical patient and asked PCPs to make clinical judgments. Results A minority (32%) of PCPs reported explicit PWID bias. The IAT indicated strong implicit PWID bias (meant IAT score = 0.59, p < .0001) among 88% of the sample. Only 9% of PCPs had no implicit or explicit PWID bias. PWID patients were judged as less likely to adhere to a PrEP regimen, less responsible, and less HIV safety conscious than heterosexual or gay male patients. Anticipated lack of adherence mediated PCPs’ intent to prescribe PrEP to PWID. Conclusions PCPs’ bias may contribute to PrEP being under-prescribed to PWID. Implicit and explicit PWID biases were common in our sample. This study illustrates the need to develop and test tailored interventions to decrease biases against PWID in primary care settings.

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“…While research on novel PrEP modalities (e.g., injectable) to address some of these barriers has identified acceptability of new methods, it was conducted among sexual minority men and did not focus on PWID [ 22 ]. Further, findings suggest general acceptability and efficacy of oral Emtricitabine + TAF/TDF among PWID [ 20 , 25 , 26 ]; however, research on acceptability of injectable PrEP with this population is still limited [ 27 , 28 ]. Our study aimed to identify the acceptability of LA injectable PrEP among PWID.…”

Section: Introductionmentioning

confidence: 99%

Acceptability of injectable pre-exposure prophylaxis among people who inject drugs in three urban U.S. settings

King

Shah²,

Randall³

et al. 2022

BMC Infect Dis

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Background Outbreaks of new HIV transmission among people who inject drugs (PWID) are a major public health concern. Oral daily PrEP, has been identified as a critical addition to the biomedical toolkit for this population. However, limited research on the acceptability of long-acting injectable PrEP has been conducted with this population. Methods We conducted a cross sectional multi-site survey with 1127 participants from May 2019–February 2020 to assess the acceptability of novel PrEP regimens. We computed bivariate and multivariable logistic regressions to evaluate correlates of the outcome variable: acceptability of 3-month injectable-PrEP. SAS v.9.4 was used to conduct statistical analysis. Results Limited knowledge of or use of PrEP, past or present, was evident within the sample. Injection drug use in the past six months was significantly associated with LA injectable PrEP acceptability, with the odds of acceptability being 1.885 (CI: 1.376, 2.582) times greater than those who did not inject drugs. After adjusting for confounders, injection drug use was significantly associated with the outcome, such that the odds of acceptability of LA injectable PrEP were 1.705 (CI: 1.198, 2.427) times greater among PWID compared to those who did not inject drugs (p < 0.03). The results demonstrate acceptability (38.2%) in a durable (3-month) injectable PrEP modality among participants who also identified as PWID. Conclusions PrEP promotion efforts among PWID to increase access to long-acting injectable PrEP are necessary. Through efforts to increase acceptance and regular use of long-acting injectable PrEP, public health strategies may be able to effectively lessen chances of future HIV outbreaks among PWID.

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The Past, Present, and Future of PrEP implementation Among People Who Use Drugs

Cited by 32 publications

References 113 publications

Patient and Provider Perspectives on a Novel, Low-Threshold HIV PrEP Program for People Who Inject Drugs Experiencing Homelessness

Patient and Provider Perspectives on a Novel, Low-Threshold HIV PrEP Program for People Who Inject Drugs Experiencing Homelessness

Provider Implicit Bias in Prescribing HIV Pre-exposure Prophylaxis (PrEP) to People Who Inject Drugs

Acceptability of injectable pre-exposure prophylaxis among people who inject drugs in three urban U.S. settings

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