PrEP for people who use opioids: A NIDA clinical trials network survey study in Southern U.S. cities where HIV incidence is high

Mary A Hatch; Tanja C Laschober; Margaret Paschen-Wolff; Melissa M Ertl; C Mindy Nelson; Lynette Wright; Chloe Lancaster; Daniel J Feaster; David Forrest; Colby Hankey; Mauda Monger; Joshua P Fegley; Rhonda Irving; Cynthia Young; Juliana Rose; Anya Spector; Lauren Dresser; Landhing Moran; Eve Jelstrom; Susan Tross

doi:10.1016/j.drugalcdep.2024.111133

PrEP for people who use opioids: A NIDA clinical trials network survey study in Southern U.S. cities where HIV incidence is high

Drug Alcohol Depend. 2024 Apr 1:257:111133. doi: 10.1016/j.drugalcdep.2024.111133. Epub 2024 Feb 23.

Authors

Mary A Hatch¹, Tanja C Laschober², Margaret Paschen-Wolff³, Melissa M Ertl⁴, C Mindy Nelson⁵, Lynette Wright², Chloe Lancaster⁶, Daniel J Feaster⁵, David Forrest⁷, Colby Hankey⁸, Mauda Monger⁹, Joshua P Fegley¹⁰, Rhonda Irving¹¹, Cynthia Young¹¹, Juliana Rose¹², Anya Spector¹³, Lauren Dresser¹⁴, Landhing Moran¹⁵, Eve Jelstrom¹⁴, Susan Tross¹⁶

Affiliations

¹ University of Washington Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, Seattle, WA 98185, USA. Electronic address: hatchm@uw.edu.
² University of Washington Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, Seattle, WA 98185, USA.
³ Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center at New York State Psychiatric Institute, New York, NY 10032, USA.
⁴ University of Minnesota-Twin Cities, Department of Psychology, Minneapolis, MN 55455, USA.
⁵ University of Miami Miller School of Medicine, Department of Public Health Sciences, Miami, FL 33136, USA.
⁶ University of South Florida, Department of Leadership, Policy, and Lifelong Learning, Tampa, FL 33620, USA.
⁷ University of Miami, Department of Anthropology, Coral Gables, FL, USA.
⁸ Aspire Health Partners, HIV Services, Orlando, FL 32804, USA.
⁹ My Brother's Keeper, 710 Avignon Dr, Ridgeland, MS 39157, USA.
¹⁰ CrescentCare, 330 Tulane Ave, 1st Floor, New Orleans, LA 70119, USA.
¹¹ Capitol Area Reentry Program, Baton Rouge, LA 70807, USA.
¹² Gateway Community Services, Research Department, Jacksonville, FL, USA.
¹³ Stella and Charles Guttman Community College, City University of New York, New York, NY, USA.
¹⁴ The Emmes Company, Rockville, MD 20850, USA.
¹⁵ Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA.
¹⁶ HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY 10032, USA.

PMID: 38447393
DOI: 10.1016/j.drugalcdep.2024.111133

Abstract

Background: People who use opioids (PWUO) are at increased risk for HIV. Pre-exposure prophylaxis (PrEP) is effective but underutilized as HIV prevention among PWUO. This study examined predictors of willingness to take daily oral PrEP and long-acting injectable (LAI) PrEP among PWUO across eight Southern urban cities with high HIV incidence.

Methods: HIV-negative PWUO (N = 308) seeking services in community-based programs participated in this cross-sectional survey study. Measures included demographics, sexual risk behavior, substance use frequency, and awareness of and willingness to take oral and injectable PrEP. Data were analyzed using mixed-effects models.

Results: Willingness to take daily oral and LAI PrEP was moderately high (69.16% and 62.02%, respectively). Half had heard of PrEP, but only 4% had ever taken it. Only education and condomless vaginal sex predicted willingness to take oral PrEP. Only education predicted willingness to take LAI PrEP. Polysubstance use was prevalent, with substantial proportions of PWUO reporting frequent use of injection drugs (opioids or stimulants, 79.5%), non-injection opioids (73.3%), non-injection stimulants (71.1%), cannabis (62.6%), and hazardous drinking (29.6%). About 20% reported past-year condomless anal sex, and one-third reported past-year condomless vaginal sex.

Conclusions: PWUO in this study were amenable to PrEP, particularly in light of education and condomless vaginal sex. Careful consideration for matching PrEP messaging to the PWUO audience is needed. PrEP promotion should expand beyond men who have sex with men to include groups such as these predominantly heterosexual, polysubstance-using PWUO with HIV risk who were open to both formulations of PrEP.

Keywords: HIV risk; Opioid use; PrEP; Southeastern United States; Substance use.

MeSH terms

Analgesics, Opioid / therapeutic use
Anti-HIV Agents* / therapeutic use
Cities
Cross-Sectional Studies
Female
HIV Infections* / drug therapy
HIV Infections* / epidemiology
HIV Infections* / prevention & control
Homosexuality, Male
Humans
Incidence
Male
Nitrosamines*
Patient Acceptance of Health Care
Pre-Exposure Prophylaxis*
Sexual and Gender Minorities*

Substances

Analgesics, Opioid
N-nitrosoiminodiacetic acid
Anti-HIV Agents
Nitrosamines

Abstract

MeSH terms

Substances

Grants and funding