Centering autonomy and choice to support oral PrEP utilization among people who inject drugs: qualitative lessons from HPTN 094 INTEGRA

Amaya Perez-Brumer, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. a.perezbrumer@utoronto.ca.
Rose Schmidt, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
Rebecca Kennedy, Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, USA.
Jordan E. Lake, Department of Internal Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA.
Yolanda R. Villarreal, Department of Internal Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA.
Sydney Bornstein, Department of Family and Community Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA.
Irene Kuo, Department of Family and Community Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA.
Omar Nieto, George Washington University Milken School of Public Health, Washington, DC, USA.
Julie Franks, Department of Family Medicine, University of California, Los Angeles, CA, United States of America.
Cecile Denis, Columbia University, ICAP Mailman School of Public Health, New York, NY, USA.
Nabila El-Bassel, Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
Steve Shoptaw, Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
Peter Davidson, Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, USA.
Laramie R. Smith, Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, USA.

Document Type

Journal Article

Publication Date

12-18-2024

Journal

Addiction science & clinical practice

Volume

19

Issue

1

DOI

10.1186/s13722-024-00520-3

Keywords

HIV prevention trials network; Integrated care; People who inject drugs; PrEP; Pre-exposure prophylaxis; Qualitative research

Abstract

BACKGROUND: Oral Pre-exposure prophylaxis (PrEP) is effective in preventing HIV transmission. However, despite high rates of HIV risk behaviors among people who inject drugs (PWID), this population remains underserved by current HIV prevention efforts in the United States. To address this challenge, we conducted an in-depth exploration of perspectives on using oral PrEP among PWID engaged in the HIV Prevention Trials Network (HPTN) 094 INTEGRA Study. METHODS: Guided by the Practical, Robust, Implementation, and Sustainability Model (PRISM), our qualitative study drew on semi-structured interviews conducted as part of the embedded implementation science evaluation of HPTN 094 INTEGRA. Seventy-seven PWID participants from five sites across New York City, Houston, Los Angeles, Philadelphia, and Washington DC were interviewed to assess intervention delivery, care access, and engagement sustainability. Audio files were transcribed verbatim and analyzed via an inductive and deductive thematic approach. RESULTS: Most participants (n = 46, 59.7%) discussed oral PrEP during their interview, though not directly prompted. Participants discussing PrEP had a mean age of 41.6 years and were predominantly white (54.3%) and cisgender men (60.9%). Among these, 15 participants described using PrEP. All participants had facilitated access to oral PrEP. Yet, the choice to use PrEP was influenced by personal risk perceptions, (mis)information about PrEP, and external factors (i.e. housing, financial security), which, for some, limited the autonomy to use PrEP. Two key themes emerged among participants using PrEP: ease of access and perceptions of high HIV risk. Those not using PrEP described two themes: low risk perception and prioritizing more urgent needs. Among participants not using PrEP a subgroup commonly described ambivalent interest, PrEP knowledge gaps, and PrEP readiness (i.e., contemplation). CONCLUSIONS: Qualitative findings highlight that facilitated PrEP access was insufficient to motivate use for many participants. Rather, PrEP decision-making process (i.e., choice) was linked to risk perception and individuals' capability to leverage PrEP as a resource based on their circumstances (i.e., autonomy). Participants' descriptions of the centrality of choice and autonomy for PrEP use underscore that ease of access is a necessary pre-condition, but person-centered interventions should also address housing, financial stability, and urgent medical conditions to promote PrEP utilization among PWID. CLINICAL TRIAL REGISTRATION: NCT04804027.

Department

Public Health Student Works

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