Willingness to use HIV pre-exposure prophylaxis among community-recruited, older people who inject drugs in Washington, DC

Kuo, Irene; Olsen, Halli; Patrick, Rudy; Phillips, Gregory; Magnus, Manya; Opoku, Jenevieve; Rawls, Anthony; Peterson, James A.; Hamilton, Flora; Kharfen, Michael; Greenberg, Alan E.

doi:10.1016/j.drugalcdep.2016.02.044

Cited by 68 publications

(49 citation statements)

References 13 publications

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“…This represents missed opportunities to initiate, or at least discuss, PrEP among PWUD. Limited PrEP awareness and use among PWUD here is similar to that reported elsewhere among female sex workers in China (Peng et al, 2012) and among other studies of PWUD in the U.S. (Kuo et al, 2016; Stein et al, 2014), but PrEP awareness was lower than that reported in studies of MSM (Ferrer et al, 2016; Goedel et al, 2016; Hoagland et al, 2016; Young et al, 2013). The higher level of knowledge about PrEP in MSM may stem from a number of PrEP initiatives that have primarily focused on MSM and HIV seronegative partners in sero-discordant couples (Ware et al, 2012).…”

Section: Discussionsupporting

confidence: 85%

“…A new PrEP cascade (Liu et al, 2012) suggests that PrEP uptake and optimal protective effect requires a high level of user awareness, willingness to initiate, and ability to remain highly adherent to the medication (Peng et al, 2012). Most recent studies that focus on PrEP uptake factors are concentrated on samples of MSM (Ferrer et al, 2016; Goedel et al, 2016; Gredig et al, 2016; Hoagland et al, 2016; Peng et al, 2012; Young et al, 2013), with limited research among high-risk PWUD (Kuo et al, 2016; Stein et al, 2014). For example, Stein et al (2014) found that 47% of PWUD reported being willing to use PrEP and that a higher perception of HIV susceptibility was associated with an increased willingness to initiate PrEP (Stein et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

“…For example, Stein et al (2014) found that 47% of PWUD reported being willing to use PrEP and that a higher perception of HIV susceptibility was associated with an increased willingness to initiate PrEP (Stein et al, 2014). Among older people who inject drugs (PWID), Kuo et al (2016) found that only 13.4% had ever heard of PrEP and 71% were likely to take PrEP (Kuo et al, 2016). Furthermore, prior studies have not evaluated how people anticipate their risk-related behaviors will change if they start PrEP.…”

Section: Introductionmentioning

confidence: 99%

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Correlates of willingness to initiate pre-exposure prophylaxis and anticipation of practicing safer drug- and sex-related behaviors among high-risk drug users on methadone treatment

Shrestha

Karki

Altice

et al. 2017

Drug and Alcohol Dependence

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Background Although people who use drugs (PWUD) are key populations recommended to receive pre-exposure prophylaxis (PrEP) to prevent HIV, few data are available to guide PrEP delivery in this underserved group. We therefore examined the willingness to initiate PrEP and the anticipation of HIV risk reduction while on PrEP among high-risk PWUD. Methods In a cross-sectional study of 400 HIV-negative, opioid dependent persons enrolled in a methadone program and reporting recent risk behaviors, we examined independent correlates of being willing to initiate PrEP. Results While only 72 (18%) were aware of PrEP, after being given a description of it, 251 (62.7%) were willing to initiate PrEP. This outcome was associated with having neurocognitive impairment (aOR=3.184, p=0.004) and higher perceived HIV risk (aOR=8.044, p<0.001). Among those willing to initiate PrEP, only 12.5% and 28.2%, respectively, indicated that they would always use condoms and not share injection equipment while on PrEP. Consistent condom use was associated with higher income (aOR=8.315, p=0.016), always using condoms with casual partners (aOR=6.597, p=0.001), and inversely associated with ongoing drug injection (aOR=0.323, p=0.027). Consistent safe injection, however, was inversely associated with age (aOR=0.948, p=0.035), ongoing drug injection (aOR=0.342, p<0.001), and perceived HIV risk (aOR=0.191, p=0.019). Conclusions While willingness to initiate PrEP was high and correlated with being at elevated risk for HIV, anticipated higher risk behaviors in this group even while on PrEP suggests that the next generation of HIV prevention approaches may need to combine biomedical and behavioral components to sustain HIV risk reduction over time.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Correlates of willingness to initiate pre-exposure prophylaxis and anticipation of practicing safer drug- and sex-related behaviors among high-risk drug users on methadone treatment

Shrestha

Karki

Altice

et al. 2017

Drug and Alcohol Dependence

View full text Add to dashboard Cite

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“…In the US, there has been considerable increase in studies assessing willingness to use PrEP, especially among MSM, but limited research has been focused among PWUD [20–27]. With regard to PWID, two studies have been published so far, which showed that very few people (7% – 13%) were aware of PrEP and fairly low willingness to use PrEP for HIV prevention (~ 50%), compared to MSM [23, 26]. This is alarming since PWUD frequently report engaging in high-risk behaviors across both sexual and drug use domains and could greatly benefit from the use of PrEP.…”

Section: Introductionmentioning

confidence: 99%

Willingness to Use Pre-Exposure Prophylaxis (PrEP): An Empirical Test of the Information-Motivation-Behavioral Skills (IMB) Model among High-Risk Drug Users in Treatment

et al. 2016

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Evidence from recent pre-exposure prophylaxis (PrEP) trials has demonstrated its safety and efficacy in significantly reducing the risk of HIV acquisition for those who are at considerable risk of acquiring HIV infection. With a rapid increase in the amount of research on the efficacy of PrEP for HIV prevention, complementary research on the willingness to use PrEP has grown, especially among MSM, but limited research has been focused among people who use drugs (PWUD). As part of the formative process, we utilized the Information-Motivation-Behavioral Skills (IMB) model of health behavior change to characterize and guide intervention development for promoting willingness to use PrEP among high-risk PWUD. The analysis included 400 HIV-negative high-risk PWUD enrolled in a community-based methadone maintenance treatment who reported drug- and/or sex-related HIV risk behaviors in the past 6-months. Analyses revealed support for the IMB model as PrEP-related behavioral skills were found to mediate the influence of PrEP-related information and motivation on willingness to use PrEP. The results provide evidence as to the utility of the IMB model to increase willingness to use PrEP among high-risk PWUD. It therefore makes an important contribution to our understanding of the applicability of theoretically-grounded models of willingness to use PrEP among high-risk PWUD, who are one of the key risk populations who could benefit from the use of PrEP.

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“…In conclusion, we seek to build upon the community views in the International Network of People who Use Drugs (INPUD) report [9] in pursuing truly comprehensive rights-based, community-driven HIV prevention and exploring an appropriate role for PrEP within this framework. HIV prevention strategy must emphasize policy issues of decriminalizing drug use, engaging communities in decision-making and fostering implementation of evidence-based interventions that remain grossly underutilized.…”

Section: Pre-exposure Prophylaxis (Prep) For People Who Inject Drugs:mentioning

confidence: 99%

Some PWID communities are ready for PrEP, so what's next?

et al. 2016

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Willingness to use HIV pre-exposure prophylaxis among community-recruited, older people who inject drugs in Washington, DC

Cited by 68 publications

References 13 publications

Correlates of willingness to initiate pre-exposure prophylaxis and anticipation of practicing safer drug- and sex-related behaviors among high-risk drug users on methadone treatment

Correlates of willingness to initiate pre-exposure prophylaxis and anticipation of practicing safer drug- and sex-related behaviors among high-risk drug users on methadone treatment

Willingness to Use Pre-Exposure Prophylaxis (PrEP): An Empirical Test of the Information-Motivation-Behavioral Skills (IMB) Model among High-Risk Drug Users in Treatment

Some PWID communities are ready for PrEP, so what's next?

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