Although resource-intensive, a tailored HIV pre-exposure prophylaxis (PrEP) delivery service resulted in increased uptake and adherence in individuals who inject drugs, according to results of a study published in HIV Medicine.

In order to address an HIV infection outbreak among individuals who inject drugs in Glasgow, Scotland, researchers evaluated a tailored PrEP service for those who experienced service barriers to health care, had poor health literacy, and tended to underestimate their HIV infection risk. The service evaluation was for a 2-year period between November 2018 and November 2020.

The service was embedded within a health program known to be acceptable among individuals who inject drugs. The model relied upon experienced sexual health outreach nurses, a physician who specialized in HIV infection, a pharmacist, and a pharmacy technician. In addition, the PrEP service was based in a local health center that provides care for individuals who are homeless.


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Because PrEP was dispensed at community pharmacies alongside opiate substitution therapy, pharmacists were enlisted to help monitor PrEP adherence. If there was a lapse in adherence, sexual health nurses would contact the individual via phone to determine the reason for the lapse and facilitate PrEP reinitiation.

Among a total of 47 participants included in the analysis, the mean age was 36 (range, 19-48) years, 55.3% were women, 91.5% were homeless, 87.2% were currently injecting drugs, and 55.3% had active hepatitis C virus infection. Treatment with PrEP was recommended for 87.2% (n=41) of participants; the remaining 6 were deemed to have decreased risk for HIV infection due to incarceration or in-patient rehabilitation.

Of the 41 participants for whom PrEP was recommended, 32 (78%) initiated PrEP treatment. With the exception of 1 participant, the remaining 31 underwent regular HIV serology monitoring. “The proportion of PrEP-covered days was 3320/3400 days (97.6%),” noted the researchers. Within the 2-year follow-up period, none of the 32 participants who received PrEP were diagnosed with HIV infection.

This study was limited by its small sample size and the lack of generalizability to other health care settings.

“To achieve elimination of HIV transmission by 2030, prevention approaches including PrEP must reach individuals at [increased risk for] HIV [infection], including key populations,” the researchers noted. “Although [PrEP] services are resource-intensive, equity of access to HIV prevention is vital for both population health and human rights,” the researchers concluded.

Reference

Grimshaw C, Lynsey B, Smith M, Estcourt CS, Metcalfe R. Evaluation of an inner city HIV pre-exposure prophylaxis service tailored to the needs of people who inject drugs. HIV Med. 2021;22(10):965-970. doi:10.1111/hiv.13181