Abstract
Introduction: Despite unequivocal evidence supporting the use of pre-exposure prophylaxis (PrEP), its scale-up has been gradual overall, and nearly absent among people who use drugs (PWUD). In the present study, we implemented the use of PrEP, as a part of an integrated HIV prevention approach, and explored the experiences and attitudes related to PrEP use among PWUD.Methods: Between September 2016 and July 2017, we recruited 40 HIV-uninfected, methadone-maintained people, who reported HIV-risk behaviors, and were currently taking PrEP. We conducted both quantitative and in-depth semi-structured qualitative interviews that primarily focused on experiences, attitudes, acceptability, disclosure status, risk compensation-related attitudes, and barriers related to PrEP adherence.Results: Results showed that participants were highly satisfied and perceived PrEP as valuable and acceptable for HIV prevention. Participants reported high adherence to PrEP. The most highly endorsed facilitators to PrEP adherence were use of memory aids, no out-of-pocket cost, perceived benefit, and support from social network. The barriers to adherence included side-effects, stigmatization, requirement of daily dosing, and accessibility of PrEP services. Additionally, participants expressed disagreement with the overall risk compensation-related attitudes (i.e., decreased personal concern about engaging in HIV risk behavior due to their perception that PrEP is now fully protecting them from contracting HIV) and indicated no increased engagement in risk behaviors while on PrEP.Conclusions: The results from the current study provide preliminary evidence supporting the successful integration of PrEP within the substance abuse treatment setting, where high risk PWUD are concentrated.
Highlights
Despite unequivocal evidence supporting the use of pre-exposure prophylaxis (PrEP), its scale-up has been gradual overall, and nearly absent among people who use drugs (PWUD)
In the United States (US), the Centers for Disease Control and Prevention (CDC) estimates that preexposure prophylaxis (PrEP) could benefit 1 in 4 adult men who have sex with men (MSM), 1 in 5 people who inject drugs (PWID: who are subset of PWUD group), and 624,000 heterosexually active adults, three-quarters of whom are women [13]
Primary care physicians at the substance abuse treatment clinic were noted as the top source of PrEP prescriptions
Summary
Despite unequivocal evidence supporting the use of pre-exposure prophylaxis (PrEP), its scale-up has been gradual overall, and nearly absent among people who use drugs (PWUD). Recent largescale PrEP trials have shown PrEP to be safe, well tolerated, and highly efficacious in reducing the risk of HIV acquisition in individuals at increased risk for infection [7,8,9,10,11]. Based on these trials, the Centers for Disease Control and Prevention (CDC) made recommendations and provided clinical practice guidelines on the use of PrEP for HIV prevention among most-at-risk populations, including PWUD [12]. The requirement for daily contact with service providers for methadone administration may allow the counselors/nurses to monitor clients’ adherence to medication through directly observed therapy (DOT)
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