Long-Acting Injectable Human Immunodeficiency Virus Pre-Exposure Prophylaxis Preferred Over Other Modalities Among People Who Inject Drugs: Findings from a Qualitative Study in California

Angela R Bazzi, Chad J Valasek, Samantha A Streuli, Carlos F Vera, Alicia Harvey-Vera, Morgan M Philbin, Katie B Biello, Alexis M Roth, Steffanie A Strathdee, Heather A Pines, Angela R Bazzi, Chad J Valasek, Samantha A Streuli, Carlos F Vera, Alicia Harvey-Vera, Morgan M Philbin, Katie B Biello, Alexis M Roth, Steffanie A Strathdee, Heather A Pines

Abstract

People who inject drugs (PWID) have extraordinarily low uptake of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) despite high levels of need. Long-acting PrEP modalities hold promise for HIV prevention among PWID, but product preferences remain poorly understood. From September to November 2021, we conducted qualitative interviews with 28 HIV-negative, adult (≥18 years) PWID in San Diego County, CA, to explore their perspectives on daily oral PrEP pills and long-acting PrEP modalities (i.e., injections, implants, intravaginal rings, and broadly neutralizing antibodies), which we explained using standard scripts. Thematic analysis identified variations in PrEP modality interest and acceptability. We identified three key factors across the 28 interviews that appeared to influence PrEP modality preferences: perceived convenience of use, invasiveness, and familiarity (based on past experience). Overall, most participants preferred injectable PrEP over other modalities because they viewed injectable medications as convenient, noninvasive, and familiar. While injectable PrEP was recently approved for use in the United States and was most the acceptable PrEP modality in this sample, our findings suggest that intervention and implementation research is urgently needed to improve our understanding of strategies that could support access, uptake, and sustained adherence to longer-acting PrEP for PWID.

Keywords: HIV prevention; acceptability; cabotegravir; intravenous; long-acting HIV prevention and treatment; pre-exposure prophylaxis; substance use.

Conflict of interest statement

K.B.B. received unrestricted research grants from Merck. All other authors report no conflicts or competing interests to declare.

References

    1. Alpren C, Dawson EL, John B, et al. . Opioid use fueling HIV transmission in an urban setting: An outbreak of HIV infection among people who inject drugs-Massachusetts, 2015–2018. Am J Public Health 2020;110:37–44.
    1. Cranston K, Alpren C, John B, et al. . Notes from the field: HIV diagnoses among persons who inject drugs—Northeastern Massachusetts, 2015–2018. MMWR Morb Mortal Wkly Rep 2019;68:253.
    1. McCarthy M. Indiana declares health emergency in response to HIV outbreak. BMJ 2015;350:h1708.
    1. Conrad C, Bradley HM, Broz D, et al. . Community outbreak of HIV infection linked to injection drug use of oxymorphone—Indiana, 2015. MMWR Morb Mortal Wkly Rep 2015;64:443–444.
    1. Adams J. HIV Outbreak in Indiana. N Engl J Med 2015;373:1379–1380.
    1. Golden MR, Lechtenberg R, Glick SN, et al. . Outbreak of human immunodeficiency virus infection among heterosexual persons who are living homeless and inject drugs—Seattle, Washington, 2018. MMWR Morb Mortal Wkly Rep 2019;68:344.
    1. Evans ME, Labuda SM, Hogan V, et al. . Notes from the field: HIV Infection investigation in a rural area—West Virginia, 2017. MMWR Morb Mortal Wkly Rep 2018;67:257–258.
    1. Hershow RB, Wilson S, Bonacci RA, et al. . Notes from the field: HIV outbreak during the COVID-19 pandemic among persons who inject drugs—Kanawha County, West Virginia, 2019–2021. MMWR Morb Mortal Wkly Rep 2022;71:66–68.
    1. U.S. Centers for Disease Control and Prevention. HIV Infection Risk, Prevention, and Testing Behaviors among Persons Who Inject Drugs—National HIV Behavioral Surveillance: Injection Drug Use, 23 U.S. Cities, Atlanta, GA: Centers for Disease Control and Prevention, 2018. 2020.
    1. Spiller MW, Broz D, Wejnert C, et al. . HIV infection and HIV-associated behaviors among persons who inject drugs—20 cities, United States, 2012. MMWR Morb Mortal Wkly Rep 2015;64:270–275.
    1. U.S. Centers for Disease Control and Prevention. Fact Sheet: HIV Injection and Drug Use. Atlanta, GA: Centers for Disease Control and Prevention, 2015.
    1. Edeza A, Bazzi A, Salhaney P, et al. . HIV pre-exposure prophylaxis for people who inject drugs: The context of co-occurring injection- and sexual-related HIV risk in the U.S. Northeast. Subst Use Misuse 2020;55:525–533.
    1. Massachusetts Department of Public Health. Data Brief: Opioid-Related Overdose Deaths among Massachusetts Residents. Boston, MA: Massachusetts Department of Public Health, 2019.
    1. Gladden RM, O'Donnell J, Mattson CL, Seth P. Changes in opioid-involved overdose deaths by opioid type and presence of benzodiazepines, cocaine, and methamphetamine—25 States, July–December 2017 to January–June 2018. MMWR Morb Mortal Wkly Rep 2019;68:737.
    1. Lambdin BH, Bluthenthal RN, Zibbell JE, Wenger L, Simpson K, Kral AH. Associations between perceived illicit fentanyl use and infectious disease risks among people who inject drugs. Int J Drug Policy 2019;74:299–304.
    1. Taylor JL, Walley AY, Bazzi AR. Stuck in the window with you: HIV exposure prophylaxis in the highest risk people who inject drugs. Subst Abus 2019;40:441–443.
    1. Fauci AS, Redfield RR, Sigounas G, Weahkee MD, Giroir BP. Ending the HIV epidemic: A plan for the United States. JAMA 2019;321:844–845.
    1. Halkitis PN, Mukherjee PP, Palamar JJ. Longitudinal modeling of methamphetamine use and sexual risk behaviors in gay and bisexual men. AIDS Behav 2009;13:783.
    1. County of San Diego Health and Human Services Agency Epidemiology and Immunization Services Branch. HIV/AIDS Epidemiology Report-2016. San Diego: County of San Diego Health & Human Services Agency, Public Health Services; 2017.
    1. Wooten S. HIV Disease in San Diego County, 2020. Presentation on behalf of the HIV Epidemiology Unit, County of San Diego Health and Human Services Agency Public Health Services. In: Paper Presented at: SD CFAR EHE Scientific Working Group Meeting 2021; Virtual.
    1. Mehta SR, Wertheim JO, Brouwer KC, et al. . HIV Transmission networks in the San Diego-Tijuana Border Region. EBioMedicine 2015;2:1456–1463.
    1. Vrancken B, Mehta SR, Avila-Rios S, et al. . Dynamics and dispersal of local human immunodeficiency virus epidemics within San Diego and across the San Diego-Tijuana Border. Clin Infect Dis 2021;73:e2018–e2025.
    1. Pines HA, Mehta SR, Abramovitz D, et al. . Dynamics of HIV transmission between high-risk populations in Tijuana. In: Paper Presented at: Conference on Retroviruses and Opportunistic Infections (CROI) 2021; virtual.
    1. Horyniak D, Wagner KD, Armenta RF, Cuevas-Mota J, Hendrickson E, Garfein RS. Cross-border injection drug use and HIV and hepatitis C virus seropositivity among people who inject drugs in San Diego, California. Int J Drug Policy 2017;47:9–17.
    1. Aspinall EJ, Nambiar D, Goldberg DJ, et al. . Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: A systematic review and meta-analysis. Int J Epidemiol 2013;43:235–248.
    1. Bernard CL, Owens DK, Goldhaber-Fiebert JD, Brandeau ML. Estimation of the cost-effectiveness of HIV prevention portfolios for people who inject drugs in the United States: A model-based analysis. PLoS Med 2017;14:e1002312.
    1. Metzger DS, Donnell D, Celentano DD, et al. . Expanding substance use treatment options for HIV prevention with Buprenorphine-Naloxone: HIV Prevention Trials Network 058 (HPTN 058). J Acquir Immune Defic Syndr 2015;68:554.
    1. Glick SN, Prohaska SM, LaKosky PA, Juarez AM, Corcorran MA, Des Jarlais DC. The impact of COVID-19 on syringe services programs in the United States. AIDS Behav 2020;24:2466–2468.
    1. Taylor JL, Ruiz-Mercado G, Sperring H, Bazzi AR. A collision of crises: Addressing an HIV outbreak among people who inject drugs in the midst of COVID-19. J Subst Abuse Treat 2021;124:108280.
    1. Choopanya K, Martin M, Suntharasamai P, et al. . Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): A randomised, double-blind, placebo-controlled phase 3 trial. Lancet 2013;381:2083–2090.
    1. Chou R, Evans C, Hoverman A, et al. . Preexposure prophylaxis for the prevention of HIV infection: Evidence report and systematic review for the US Preventive Services Task Force. JAMA 2019;321:2214–2230.
    1. Earlywine JJ, Bazzi AR, Biello KB, Klevens RM. High prevalence of indications for pre-exposure prophylaxis among people who inject drugs in Boston, Massachusetts. Am J Prev Med 2021;60:369–378.
    1. Bazzi AR, Biancarelli DL, Childs E, et al. . Limited knowledge and mixed interest in pre-exposure prophylaxis for HIV prevention among people who inject drugs. AIDS Patient Care STDS 2018;32:529–537.
    1. Biello KB, Bazzi AR, Mimiaga MJ, et al. . Perspectives on HIV pre-exposure prophylaxis (PrEP) utilization and related intervention needs among people who inject drugs. Harm Reduct J 2018;15:55.
    1. Bazzi AR, Drainoni ML, Biancarelli DL, et al. . Systematic review of HIV treatment adherence research among people who inject drugs in the United States and Canada: Evidence to inform pre-exposure prophylaxis (PrEP) adherence interventions. BMC Public Health 2019;19:31.
    1. Biancarelli DL, Biello KB, Childs E, et al. . Strategies used by people who inject drugs to avoid stigma in healthcare settings. Drug Alcohol Depend 2019;198:80–86.
    1. Motavalli D, Taylor JL, Childs E, et al. . “Health Is on the Back Burner:” Multilevel barriers and facilitators to primary care among people who inject drugs. J Gen Intern Med 2021;36:129–137.
    1. Kota KK, Mansergh G, Stephenson R, Hirshfield S, Sullivan P. Sociodemographic characteristics of HIV pre-exposure prophylaxis use and reasons for nonuse among gay, bisexual, and other men who have sex with men from three US Cities. AIDS Patient Care STDS 2021;35:158–166.
    1. Leech AA, Biancarelli D, Aaron E, et al. . HIV pre-exposure prophylaxis for conception among HIV serodiscordant couples in the United States: A cohort study. AIDS Patient Care STDS 2020;34:295–302.
    1. Tao J, Montgomery MC, Williams R, et al. . Loss to follow-up and re-engagement in HIV pre-exposure prophylaxis care in the United States, 2013–2019. AIDS Patient Care STDS 2021;35:271–277.
    1. Calabrese SK, Kalwicz DA, Modrakovic D, et al. . An experimental study of the effects of patient race, sexual orientation, and injection drug use on providers' PrEP-related clinical judgments. AIDS Behav 2022;26:1393–1421.
    1. Pleuhs B, Mistler CB, Quinn KG, et al. . Evidence of potential discriminatory HIV pre-exposure prophylaxis (PrEP) prescribing practices for people who inject drugs among a small percentage of providers in the U.S. J Prim Care Community Health 2022;13:21501319211063999.
    1. Edelman EJ, Moore BA, Calabrese SK, et al. . Primary care physicians' willingness to prescribe HIV pre-exposure prophylaxis for people who inject drugs. AIDS Behav 2017;21:1025–1033.
    1. Karris MY, Beekmann SE, Mehta SR, Anderson CM, Polgreen PM. Are we prepped for preexposure prophylaxis (PrEP)? Provider opinions on the real-world use of PrEP in the United States and Canada. Clin Infect Dis 2014;58:704–712.
    1. Coelho LE, Torres TS, Veloso VG, Landovitz RJ, Grinsztejn B. Pre-exposure prophylaxis 2.0: New drugs and technologies in the pipeline. Lancet HIV 2019;6:e788–e799.
    1. Biello KB, Mimiaga MJ, Valente PK, Saxena N, Bazzi AR. The past, present, and future of PrEP implementation among people who use drugs. Curr HIV/AIDS Rep 2021;18:328–338.
    1. Cambou MC, Landovitz RJ. Challenges and opportunities for preexposure prophylaxis. Top Antivir Med 2021;29:399–406.
    1. Delany-Moretlwe S, Hughes JP, Bock P, et al. . Cabotegravir for the prevention of HIV-1 in women: Results from HPTN 084, a phase 3, randomised clinical trial. Lancet 2022;399:1779–1789.
    1. Landovitz RJ, Donnell D, Clement ME, et al. . Cabotegravir for HIV prevention in cisgender men and transgender women. N Engl J Med 2021;385:595–608.
    1. Brody JK, Taylor J, Biello K, Bazzi AR. Towards equity for people who inject drugs in HIV prevention drug trials. Int J Drug Policy 2021;96:103284.
    1. Andrews CD, Bernard LS, Poon AY, et al. . Cabotegravir long acting injection protects macaques against intravenous challenge with SIVmac251. AIDS 2017;31:461–467.
    1. Baeten JM, Palanee-Phillips T, Brown ER, et al. . Use of a vaginal ring containing dapivirine for HIV-1 prevention in women. N Engl J Med 2016;375:2121–2132.
    1. Nel A, van Niekerk N, Kapiga S, et al. . Safety and efficacy of a dapivirine vaginal ring for HIV prevention in women. N Engl J Med 2016;375:2133–2143.
    1. Matthews RP, Zang X, Barrett S, et al. Next-generation Islatravir implants projected to provide yearly HIV prophylaxis. Paper presented at: Conference on Retroviruses and Opportunistic Infections (CROI); 2021. Available at: (Last accessed May 28, 2021).
    1. Wagh K, van Gils MJ, Gristick H, Schommers P. Editorial: Novel concepts in using broadly neutralizing antibodies for HIV-1 treatment and prevention. Front Immunol 2021;12:823576.
    1. World Health Organization. European Medicines Agency (EMA) approval of the dapivirine ring for HIV prevention for women in high HIV burden settings. 2020. Available at: (Last accessed May 28, 2021).
    1. European Medicines Agency. Vaginal ring to reduce the risk of HIV infection for women in non-EU countries with high disease burden. 2020. Available at: (Last accessed May 28, 2021).
    1. World Health Organization. WHO recommends the dapivirine vaginal ring as a new choice for HIV prevention for women at substantial risk of HIV infection. 2021. Available at: (Last accessed May 28, 2021).
    1. Strathdee SA, Abramovitz D, Harvey-Vera A, et al. . Prevalence and correlates of SARS-CoV-2 seropositivity among people who inject drugs in the San Diego-Tijuana border region. PLoS One 2021;16:e0260286.
    1. Heckathorn DD, Semaan S, Broadhead RS, Hughes JJ. Extensions of respondent-driven sampling: A new approach to the study of injection drug users aged 18–25. AIDS Behav 2002;6:55–67.
    1. Johnson JC. Selecting Ethnographic Informants. Newbury Park, CA: Sage Publications; 1990.
    1. Patton MQ. Qualitative Research and Evaluation Methods, 3rd ed. Thousand Oaks, CA: Sage Publications; 2002.
    1. Biello KB, Edeza A, Salhaney P, et al. . A missing perspective: Injectable pre-exposure prophylaxis for people who inject drugs. AIDS Care 2019;31:1214–1220.
    1. Biello KB, Valente PK, Lin WY, et al. . PrEParing for NextGen: Cognitive interviews to improve next generation PrEP modality descriptions for young men who have sex with men. AIDS Behav 2022;26:1956–1965.
    1. Rael CT, Martinez M, Giguere R, et al. . Transgender women's concerns and preferences on potential future long-acting biomedical HIV prevention strategies: The case of injections and implanted medication delivery devices (IMDDs). AIDS Behav 2020;24:1452–1462.
    1. Philbin MM, Bergen S, Parish C, et al. . Long-acting injectable ART and PrEP among women in six cities across the United States: A qualitative analysis of who would benefit the most. AIDS Behav 2022;26:1260–1269.
    1. Biello KB, Hosek S, Drucker MT, et al. . Preferences for injectable PrEP among young U.S. cisgender men and transgender women and men who have sex with men. Arch Sex Behav 2018;47:2101–2107.
    1. Guest G, Bunce A, Johnson L. How many interviews are enough? Field Methods 2016;18:59–82.
    1. DeCuir-Gunby JT, Marshall PL, McCulloch AW. Developing and using a codebook for the analysis of interview data: An example from a professional development research project. Field Methods 2010;23:136–155.
    1. MacQueen KM, McLellan E, Kay K, Milstein B. Codebook development for team-based qualitative analysis. CAM J 2016;10:31–36.
    1. Philbin MM, Parish C, Bergen S, et al. . A qualitative exploration of women's interest in long-acting injectable antiretroviral therapy across six cities in the women's interagency HIV study: Intersections with current and past injectable medication and substance use. AIDS Patient Care STDS 2021;35:23–30.
    1. Schneider KE, White RH, O'Rourke A, et al. . Awareness of and interest in oral pre-exposure prophylaxis (PrEP) for HIV prevention and interest in hypothetical forms of PrEP among people who inject drugs in rural West Virginia. AIDS Care 2021;33:721–728.
    1. Valente PK, Wu Y, Cohen YZ, Caskey M, Meyers K. Behavioral and social science research to support development of educational materials for clinical trials of broadly neutralizing antibodies for HIV treatment and prevention. Clin Trials 2021;18:17–27.
    1. Roth AM, Tran NK, Felsher M, et al. . Integrating HIV preexposure prophylaxis with community-based syringe services for women who inject drugs: Results from the project SHE demonstration study. J Acquir Immune Defic Syndr 2021;86:e61–e70.
    1. Strathdee SA, Abramovitz D, Harvey-Vera A, et al. Correlates of coronavirus disease 2019 (COVID-19) vaccine hesitancy among people who inject drugs in the San Diego-Tijuana Border Region. Clin Infect Dis 2021. [Epub ahead of print]; DOI: 10.1093/cid/ciab975.
    1. Degenhardt L, Mathers B, Vickerman P, Rhodes T, Latkin C, Hickman M. Prevention of HIV infection for people who inject drugs: Why individual, structural, and combination approaches are needed. Lancet 2010;376:285–301.
    1. Milloy M-J, Montaner J, Wood E. Barriers to HIV treatment among people who use injection drugs: Implications for ‘treatment as prevention’. Curr Opin HIV AIDS 2012;7:332–338.
    1. Wood E, Kerr T, Tyndall MW, Montaner JS. A review of barriers and facilitators of HIV treatment among injection drug users. AIDS 2008;22:1247–1256.
    1. Marzinke MA, Grinsztejn B, Fogel JM, et al. . Characterization of human immunodeficiency virus (HIV) infection in cisgender men and transgender women who have sex with men receiving injectable cabotegravir for HIV prevention: HPTN 083. J Infect Dis 2021;224:1581–1592.
    1. Reddy A, Lester CA, Stone JA, Holden RJ, Phelan CH, Chui MA. Applying participatory design to a pharmacy system intervention. Res Social Adm Pharm 2019;15:1358–1367.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren