Integrating HIV Preexposure Prophylaxis With Community-Based Syringe Services for Women Who Inject Drugs: Results From the Project SHE Demonstration Study.

INTRODUCTION: To guide future preexposure prophylaxis (PrEP) implementation for women who inject drugs (WWID), a population increasingly represented in new HIV cases in the United States, we present results from a demonstration project integrated within a syringe services program (SSP) in Philadelphia, PA. METHODS: WWID ≥18 years were educated about and offered 24 weeks of daily PrEP. Participants completed surveys and clinical assessments at baseline and at weeks 1, 3, 12, and 24. We used descriptive statistics to estimate feasibility/acceptability, engagement in the care cascade, HIV/sexually transmitted diseases (STI) and pregnancy, issues of safety/tolerability, and preferences/satisfaction with PrEP services. Multivariable logistic regression with generalized estimating equations was used to identify factors associated with PrEP uptake and retention. RESULTS: We recruited 136 WWID. Of those, 95 were included in the final sample, and 63 accepted a PrEP prescription at week 1. Uptake was associated with greater baseline frequency of SSP access [adjusted odds ratio (aOR) = 1.85; 95% confidence interval (CI): 1.24 to 2.77], inconsistent condom use (aOR = 3.38; 95% CI: 1.07 to 10.7), and experiencing sexual assault (aOR = 5.89; 95% CI: 1.02, 33.9). Of these 95, 42 (44.2%) were retained at week 24. Retention was higher among women who reported more frequent baseline SSP access (aOR = 1.46; 95% CI: 1.04 to 2.24). Self-reported adherence was high but discordant with urine-based quantification of tenofovir. Baseline STI prevalence was 17.9%; there were 2 HIV seroconversions and 1 pregnancy. Safety/tolerability issues were uncommon, and acceptability/satisfaction was high. CONCLUSIONS: Integrating PrEP with SSP services is feasible and acceptable for WWID. This suggests that daily PrEP is a viable prevention tool for this vulnerable population.

Applying the Behavioral Model for Vulnerable Populations to Pre-Exposure Prophylaxis Initiation Among Women Who Inject Drugs.

This study used Behavioral Model for Vulnerable Populations (BMVP) to identify factors associated with pre-exposure prophylaxis (PrEP) initiation among women who inject drugs (WWID) when PrEP was offered at a syringe services program (SSP). Participants (n = 89) were WWID, $ge18 years, and eligible for PrEP. Most (69) initiated PrEP. Chi square and t tests were used to identify bivariate relationships between BMVP factors and PrEP initiation. A greater proportion of PrEP initiators (compared to non-initiators) reported sexual assault, frequent SSP attendance, earning $ge$5,000 annually and inconsistent condom use. Findings can inform the development of gender-specific strategies to promote PrEP among WWID.

Pre-Exposure Prophylaxis (PrEP) Awareness Is Low Among Heterosexual People of Color Who Might Benefit From PrEP in Philadelphia.

INTRODUCTION: We assessed awareness of pre-exposure prophylaxis (PrEP) among HIV-negative Black and Latinx persons living in the Philadelphia Metropolitan Statistical Area. METHODS: Using chi-square and Wilcoxon rank-sum tests, we analyzed data from the 2016 heterosexual cycle of the National HIV Behavioral Surveillance system to assess how sociodemographic factors, health care utilization, and risk behaviors affected PrEP awareness. RESULTS: Participants (n = 472) were predominately Black, non-Hispanic (88.1%) with a median age of 41.5 years. Most participants reported having a usual source of medical care (92.1%) and seeing a medical provider within 12 months (87.0%). However, PrEP awareness was low in this sample (4.9%) and was lower among those who had a medical visit compared with those who had not ( P < .01). CONCLUSION: Current Centers for Disease Control and Prevention clinical guidelines suggest that providers counsel high-risk patients about PrEP. Our data suggest that this is not happening with people of color in Philadelphia. Interventions targeting medical providers working with HIV-risk people of color may be appropriate.

Factors Associated with Awareness of Pre-exposure Prophylaxis for HIV Among Persons Who Inject Drugs in Philadelphia: National HIV Behavioral Surveillance, 2015.

Persons who inject drugs (PWID) continue to experience disproportionate HIV burden. Though studies demonstrate PWID find pre-exposure prophylaxis (PrEP) acceptable, awareness and uptake remains low. Data from the 2015 PWID cycle of the National HIV Behavioral Surveillance (n = 612) in Philadelphia, Pennsylvania (USA) were analyzed to evaluate how socio-demographics and behavioral factors impact PrEP awareness. Only 12.4% of PWID surveyed were PrEP-aware and 2.6% reported receiving a prescription. Factors associated with PrEP awareness included having at least some college education (aOR 2.13, 95% CI 1.03, 4.43), sharing paraphernalia (aOR 2.37, 95% CI 1.23, 4.56), obtaining syringes/needles primarily from a syringe exchange program (aOR 2.28, 95% CI 1.35, 3.87), STI testing (aOR 1.71, 95% CI 1.01, 2.89) and drug treatment (aOR 2.81, 95% CI 1.62, 4.87). Accessing prevention and health services increased the odds of being PrEP-aware; however, awareness was low overall. Additional promotion efforts are warranted.