Using nominal group technique to identify barriers and facilitators to preventing HIV using combination same-day pre-exposure prophylaxis and medications for opioid use disorder

Abstract

Background Preventing HIV transmission among people who inject drugs (PWID) is a key element of the US Ending the HIV Epidemic strategy and includes both pre-exposure prophylaxis (PrEP) and medications for opioid use disorder (MOUD). While both lead to decreases in HIV transmission, MOUD has other social and health benefits; meanwhile, PrEP has additional HIV prevention advantages from sexual risk and the injection of stimulants. However, these medications are often prescribed in different settings and require multiple visits before initiation. Strategies to integrate these services (i.e., co-prescription) and offer same-day prescriptions may reduce demands on patients who could benefit from them. Methods Nominal group technique, a consensus method that rapidly generates and ranks responses, was used to ascertain barriers and solutions for same-day delivery of PrEP and MOUD as an integrated approach among PWID (n = 14) and clinical (n = 9) stakeholders. The qualitative portion of the discussion generated themes for analysis, and the ranks of the proposed barriers and solutions to the program are presented. Results The top three barriers among PWID to getting a same-day prescription for both PrEP and MOUD were (1) instability of insurance (e.g., insurance lapses); (2) access to a local prescriber; and (3) client-level implementation factors, such as lack of personal motivation. Among clinical stakeholders, the three greatest challenges were (1) time constraints on providers; (2) logistics (e.g., coordination between providers and labs); and (3) availability of providers who can prescribe both medications. Potential solutions identified by both stakeholders included pharmacy delivery of the medications, coordinated care between providers and health care systems (e.g., case management), and efficiencies in clinical care (e.g., clinical checklists), among others. Conclusions Implementing and sustaining a combined PrEP and MOUD strategy will require co-training providers on both medications while creating efficiencies in systems of care and innovations that encourage and retain PWID in care. Pilot testing the co-prescribing of PrEP and MOUD with quality performance improvement is a step toward new practice models.

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

“…Although PrEP services for people who inject drugs identified in this study were most commonly provided in standalone, fixed healthcare settings, a range of community-based services providing PrEP outside of clinic settings and peer-led services were also identified. These community-based and peer-led models are likely to be most acceptable to people who inject drugs [ 15 , 26 , 30 , 31 ], increasing access to and uptake of PrEP by people who inject drugs. However, there are challenges to implementing integrated PrEP services.…”

“…Dispensing PrEP through community pharmacies may increase accessibility for individuals and reduce costs [ 31 ]. In several countries, community pharmacies already dispense sterile injecting equipment and OAMT [ 32 – 34 ].…”

Leveraging existing provider networks in Europe to eliminate barriers to accessing opioid agonist maintenance therapies for Ukrainian refugees

“…Due to its qualitative nature, the study’s results reflect a situational analysis at the time of the interviews and hypothesis generation. They do not, however, provide an estimate or rank of the importance of barriers identified—which can be done through a mixed methods strategy like nominal group technique, one of the implementation tools used in NIATx [ 41 , 53 , 54 ].…”

Treatment Initiation, Substance Use Trajectories, and the Social Determinants of Health in Persons Living With HIV Seeking Medication for Opioid Use Disorder

“…21,22 Homelessness and income-assistance have been positively and negatively correlated with engagement in MOUD treatment, [23][24][25] while lack of insurance, minority race/ethnicity, and the presence of medical comorbidities may negatively affect treatment uptake. [25][26][27] Among women living with HIV, adversities and economic hardship were correlated with greater drug use than their peers during HIV treatment, 28 which may reduce the likelihood of MOUD initiation. 29,30 Access to care, treatment setting, type of MOUD, methodology and rigor of research, and a multitude of other factors may explain heterogeneity in results, and further studies are warranted.…”