Abstract
IntroductionStudies examining the use of pre-exposure prophylaxis (PrEP) to prevent HIV transmission among people who inject drugs (PWIDs) have not been adequately summarized. Recently, the Bangkok Tenofovir Study has shown that PrEP may be effective at reducing new HIV infections among this high-risk group. This randomized controlled trial was the first study to specifically examine the efficacy of PrEP among PWIDs. In this review, we present the current state of evidence regarding the use of PrEP to prevent HIV infection in PWID populations, and set an agenda for future research to inform the most effective implementation of PrEP in the context of existing evidence-based HIV prevention strategies.DiscussionDespite positive trial results confirming that PrEP may prevent HIV transmission among PWIDs, there remain many questions regarding the interpretation of these results, as well as obstacles to the implementation of PrEP regimens within highly diverse drug-using communities. Aside from the Bangkok Tenofovir Study, we identified only one other published study that has collected empirical data to inform the use of PrEP among PWIDs. The large gap in research regarding the use and implementation of PrEP for PWIDs signals the need for further research and attention.ConclusionsWe recommend that future research efforts focus on elucidating the generalizability of the Bangkok Tenofovir Study results in other injection drug–using populations, examining the willingness of PWIDs to use PrEP in diverse contexts, identifying barriers to adherence to PrEP regimens and determining the most effective ways to implement PrEP programmes within the context of existing evidence-based prevention strategies, including opioid substitution therapy and needle and syringe distribution programmes.
Highlights
Studies examining the use of pre-exposure prophylaxis (PrEP) to prevent HIV transmission among people who inject drugs (PWIDs) have not been adequately summarized
Several interventions have been shown to reduce the risk of HIV-1 acquisition among PWIDs and are recommended by the World Health Organization (WHO) and Joint United Nations Programme on HIV/AIDS (UNAIDS) [3], implementation and scale-up remain suboptimal, and many settings continue to experience on-going or accelerating epidemics of HIV among PWIDs [4]
Several successful PrEP trials have fuelled optimism that PrEP may be effective at reducing transmission among many high-risk groups [5Á8], including men who have sex with men (MSM), the negative partner in heterosexual serodiscordant couples and, most recently, PWIDs [8]
Summary
People who inject drugs (PWIDs) continue to be at high risk for HIV-1 infection, with annual parenteral transmission accounting for approximately 7% of new HIV infections in the United States and 10% of new infections globally [1,2]. Several successful PrEP trials have fuelled optimism that PrEP may be effective at reducing transmission among many high-risk groups [5Á8], including men who have sex with men (MSM), the negative partner in heterosexual serodiscordant couples and, most recently, PWIDs [8]. This optimism has been tempered by disappointing results from multiple unsuccessful trials among women [9,10], as well as a host of implementation issues, including various challenges associated with the scaleup of mass or even targeted administration strategies. In anticipation of increased research attention to the implementation of PrEP among PWIDs, as well as continued interpretation of the Bangkok Tenofovir Study results, we present here a review of the current state of evidence for the use of PrEP among PWIDs, and propose an agenda for future research
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