Photo Credit: iStock/Jacob Wackerhausen

Utilizing syringe service programs to provide comprehensive PrEP care shows promise for encouraging more people who inject drugs to engage in HIV prevention.

New research adds to the growing support for expanding pre-exposure prophylaxis (PrEP) care outside of traditional medical settings for people who inject drugs (PWID), according to findings published in Therapeutic Advances in Infectious Disease.

Expanding access to PrEP has been endorsed as a key strategy in the Ending the HIV Epidemic initiative; however, uptake among PWID has been negligible in rural areas. Syringe service programs (SSPs) offer an important opportunity to integrate PrEP services, according to study author Hilary L. Surratt, PhD, and colleagues.

Dr. Surratt and colleagues conducted a randomized pilot study comparing the preliminary efficacy of two study interventions on PrEP initiation among HIV-negative PWID. They enrolled 80 patients from two rural SSPs. Study inclusion criteria included patient age (≥18), at least one instance of injection drug use in the past month, and an indication for PrEP in the past month.

The study team randomly assigned patients to the strengths-based case management (SBCM-PrEP; n=41) intervention arm or the brief standard PrEP counseling (CDC-PrEP; n=39) arm. In both arms, patients were offered linkage to embedded PrEP providers within the SSPs for clinical PrEP screening. The primary endpoint was PrEP initiation, measured by dispensed PrEP prescription, within the 6-month study period.

Results Favor SBCM-PrEP Arm

Almost all patients (96.2%) completed at least one session of the assigned intervention. Overall, 87.5% of patients linked with the embedded PrEP provider and completed an initial clinical visit and point-of-care testing for PrEP eligibility. Additionally, 37.5% of patients completed a follow-up visit, 27.5% received a prescription, and 8.8% picked up the prescription.

In the intent-to-treat (ITT) and per protocol analyses, the researchers observed a 13.6% (ITT) and 14.9% (per protocol) difference in prescription issuance and a 12.1% (ITT) and 12.8% (per protocol) difference in the primary outcome of PrEP initiation. While these results favor the SBCM-PrEP arm, the researchers noted that neither comparison reached statistical significance.

“Though neither of these comparisons reached statistical significance due to the small sample size in the pilot trial, the effects appear to represent clinically important differences that warrant further investigation,” Dr. Surratt and colleagues wrote. “Utilizing SSPs as a venue to provide comprehensive PrEP services appears promising as a pathway to encourage more PWID to engage in HIV prevention services and may be particularly important in communities that experience a lack of PrEP providers in other healthcare settings.”