Implementing a pre-exposure prophylaxis (PrEP) promotion intervention among persons who inject drugs: Perspectives...

Clinical guidelines recommend pre-exposure prophylaxis (PrEP) to prevent HIV among persons who inject drugs (PWID), yet few are reached by this evidence-based intervention. To address this challenge, we are conducting a clinical trial to evaluate the impact of contingency management (CM) with stepped care to PrEP adherence and support services (PASS) among PWID. We sought to elicit perspectives from community- and research-based implementation partners on barriers and facilitators to implementing this intervention package as well as describe perspectives around evidence-based research practices in general.

In October 2023, we conducted three focus groups with community-based site staff (n = 8), site leadership (n = 6), and research coordinators (n = 6) involved in delivering and implementing the intervention. The Promoting Action on Research Implementation in Health Service (PARIHS) implementation science framework construct (evidence, context, and facilitation opportunities) informed qualitative data collection and analysis.

Regarding evidence, focus group participants had a mix of previous experience or backgrounds in behavioral and interventional research with pre-existing research experience and embedded research infrastructure described as implementation facilitators. Participants described initially mixed views towards CM but became more positive as participants engaged in trial implementation. Regarding context within the community-based setting, focus group participants acknowledged challenges in promoting PrEP among PWID given competing social needs as well as individual and service priorities. Participants described turnover and burnout among staff delivering the intervention in addition to providing regular day-to-day services as major barriers to implementation. Regarding future intervention facilitation opportunities, participants suggested integrating interventional activities into off-site services like outreach as well as increasing the number of CM sessions. To facilitate site engagement and localized practice improvement, site leadership emphasized the need for consistent research team presence and detailed correspondence of results at the conclusion of research.

Focus group participants identified barriers and facilitators to implementing and sustaining CM-based PrEP promotion interventions within community-based settings. Efforts should be made to anticipate and address staff capacity and turnover when implementing HIV prevention interventions within community settings. Additionally, integrating CM-based PrEP promotion programs into off-site services and operations to reach PWID could be an opportunity to increase reach.