2 - (SYM 101) Adapting Prep Delivery for People Who Use Opioid Drugs Across the Opioid Use Disorder (OUD) Treatment Cascade: Exploring Community Needs and Preferences to Improve Uptake

Background: People who use opioids (PWUO) are at increased risk of HIV infection due to a range of psychosocial risk factors (e.g., housing instability, incarceration, and discrimination) and both injection- and sex-related transmission risks. Despite this high risk, uptake of HIV pre-exposure prophylaxis (PrEP) remains low in this population. Prior research has identified numerous barriers hindering access and adherence in this population (e.g., stigma, provider access, and inconsistent transportation). This study sought to identify perceived facilitators and barriers of PrEP uptake among PWUO across various stages of the OUD treatment (Tx) cascade.

Methods: Recruitment was completed via community-based outreach and clinic referrals. Participants were 120 HIV negative PWUO in the greater Boston area (age < ![if !msEquation] >< ![if !vml] >< ![endif] >< ![endif] > 18 years). Eligible participants completed a self-report survey. The present study examined substance use and Tx history, PrEP awareness, attitudes, and intentions, preferred PrEP venues, perceived healthcare barriers, and hypothesized psychological correlates of PrEP uptake. Descriptive statistics, χ² analyses, and multivariate regression were used to explore relationships among stage of OUD Tx cascade, PrEP uptake willingness, delivery preferences, and facilitators and barriers to use.

Results: Participants had a mean age of 43.5 years (standard deviation = 10.6) and were 44% cisgender men, 66.7% White, and 80% non-Hispanic. One in four participants reported having used oral PrEP (n=30) and 5% (n=6) reported having used injectable PrEP. Few endorsed current PrEP use (n=4; 3%), although a considerable proportion agreed they were interested in beginning oral (n=45; 38%) or injectable PrEP (n=43; 36%). Preferences for PrEP formulation were split (46.7% favored injectable; 39.2% favored oral PrEP). Among those who reported using oral PrEP in the past, the most common reason cited for discontinuing the medication was forgetting to refill the prescription (n=6; 20%). Half of participants reported lack of adequate and affordable housing as being a “major problem” when accessing PrEP. Participants cited a doctor’s office (29.2%, n=35) or a mobile healthcare van (23.3%, n=28) as locations they felt most comfortable starting PrEP. 


Conclusions: A considerable share of PWUO report interest in PrEP, despite low rates of current use which may be attributable to access and adherence barriers. Current delivery practices and venues may not reflect preferences of PWUO, representing missed opportunities for enhancing PrEP uptake in PWUO.