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

Abstract

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.

Syringe Services Programs’ Role in Ending the HIV Epidemic in the U.S.: Why We Cannot Do It Without Them

“…96,100 In a study of women who inject drugs, more than two thirds initiated PrEP, although of these, only about a third remained on PrEP at Week 24 and daily adherence was low. 101 These findings suggest that SSPs offering PrEP need support to help identify and address barriers to PrEP uptake and adherence among their clients. Further, SSPs may need to develop options for direct provision or facilitating direct provision of PrEP, possibly via telehealth providers, to support low-barrier access and timely PrEP initiation.…”

Evaluation of an inner city HIV pre‐exposure prophylaxis service tailored to the needs of people who inject drugs

“…Multi‐agency working was invaluable for case finding, DOT and follow‐up. It is not reported in existing PWID PrEP models, which highlighted concerns regarding adherence [5,14]. We show that it is possible to achieve high levels of adherence with regular monitoring among this vulnerable group but it required much more intensive support than usual care within SH clinics.…”

“…Pre‐exposure prophylaxis services for PWID are relatively under‐studied. Three service models have been reported in Bangkok [5], Philadelphia [14] and Boston [15]. These sites also recruited participants from services already used by PWIDs and implemented additional measures to assist retention in care.…”

When Perfect Is the Enemy of Tested: a Call to Scale Rapid HIV Testing for People Who Inject Drugs

“…A growing body of data supports delivery of HIV screening and prevention care where PWID already spend time and access services, including non-clinical settings such as syringe service programs (SSP), mobile vans, street outreach, and pop-up harm reduction sites. 1 , 2 Many of these welcoming yet less structured environments face challenges meeting logistical and regulatory requirements for phlebotomy and must refer patients to other sites for LBT, decreasing the chances of screening completion. 3 Rapid HIV testing, done on fingerstick or oral fluid samples, is easier to implement in many low-barrier settings.…”

“…5 Frequent, rapid testing can also facilitate linkage to other HIV prevention services, including HIV pre-exposure prophylaxis (PrEP), the use of daily oral tenofovir disoproxil fumarate/ emtricitabine to prevent HIV in people who are HIV negative and have sexual-or injection-related risk. 1 Rapid and phlebotomy-based tests are also not mutually exclusive; 1 Two other medications, daily oral tenofovir alafenamide/emtricitabine and long-acting injectable cabotegravir, are also approved by the Food and Drug Administration for PrEP for people with sexual but not injection-related HIV risk. Daily tenofovir disoproxil fumarate/ emtricitabine is the only regimen with a component studied in people with injection-related risk.…”