Pre-exposure prophylaxis (PrEP) for HIV prevention among people who inject drugs: a global mapping of service delivery

Abstract

Background The World Health Organization (WHO) recommends oral pre-exposure prophylaxis (PrEP) for all people at substantial risk of HIV as part of combination prevention. The extent to which this recommendation has been implemented globally for people who inject drugs is unclear. This study mapped global service delivery of PrEP for people who inject drugs. Methods Between October and December 2021, a desk review was conducted to obtain information on PrEP services for people who inject drugs from drug user-led networks and HIV, harm reduction, and human rights stakeholders. Websites of organizations involved in HIV prevention or services for people who inject drugs were searched. Models of service delivery were described in terms of service location, provider, and package. Results PrEP services were identified in 27 countries (15 high-income). PrEP delivery models varied within and across countries. In most services, PrEP services were implemented in healthcare clinics without direct links to other harm reduction services. In three countries, PrEP services were also provided at methadone clinics. In 14 countries, PrEP services were provided through community-based models (outside of clinic settings) that commonly involved peer-led outreach activities and integration with harm reduction services. Conclusions This study indicates limited PrEP availability for people who inject drugs. There is potential to expand PrEP services for people who inject drugs within harm reduction programs, notably through community-based and peer-led services. PrEP should never be offered instead of evidence-based harm reduction programs for people who inject drugs; however, it could be offered as an additional HIV prevention choice as part of a comprehensive harm reduction program.

The use of oral HIV pre-exposure prophylaxis among people who inject drugs: barriers, and recommendations

“…To address this barrier, we recommend the community-based provision of oral PrEP. Community-based services may include clinics managed by non-governmental organizations, mobile and home-based services, telehealth linked with laboratories and pharmacies, and peer-led outreach services to cater to the homeless ( 27 ). Differentiated service delivery models can also help reduce the workload of HCWs at healthcare facilities, especially in low-to-middle-income countries that have understaffed healthcare facilities ( 28 ).…”

Uptake and persistent use of HIV pre-exposure prophylaxis (PrEP) among key populations: Results from Ukraine’s scaled national PrEP program

“…Across these regions and patient populations, research consistently illustrates limited PrEP persistence, with typically more than 50% of users discontinuing within 6-12 months, and demonstrates that younger PrEP users are more likely to discontinue PrEP than older users. [8][9][10][11][12][13][14][15][16] Although existing scientific reports have shown steady uptake of PrEP in Ukraine since 2017, 2,17,18 there are no published reports or studies on PrEP persistence, which is important for understanding effectiveness of programs. We sought to estimate PrEP persistence in KPs in Ukraine and assess associations by sex and age.…”

“…Although existing scientific reports have shown steady uptake of PrEP in Ukraine since 2017, 2,17,18 there are no published reports or studies on PrEP persistence, which is important for understanding effectiveness of programs. We sought to estimate PrEP persistence in KPs in Ukraine and assess associations by sex and age.…”

Patterns of daily oral HIV PrEP adherence among people who inject drugs in Ukraine: an analysis of biomarkers

“…Daily oral pre-exposure prophylaxis (PrEP) with tenofovir/emtricitabine (TDF/FTC) is an important component of the HIV prevention toolkit, with efficacy demonstrated among all key populations [1,2]. Despite the recommendations to prescribe PrEP to people who inject drugs (PWID), coverage remains low, services are often unavailable and national policies are lacking [3][4][5][6][7][8]. Evidence of real-life PrEP effectiveness among PWID is limited [3][4][5].…”