Changes in the PrEP Care Cascade in People Who Inject Drugs in 2018 and 2022

Area of Science:

• Public Health
• Infectious Disease Prevention
• Health Services Research

Background:

• HIV pre-exposure prophylaxis (PrEP) is a critical tool for preventing HIV transmission.
• Underutilization of PrEP among people who inject drugs (PWID) remains a significant public health challenge, even when clinically indicated.

Purpose of the Study:

• To assess changes in PrEP awareness, access, and utilization among PWID in Portland, Oregon, between 2018 and 2022.
• To identify factors associated with PrEP awareness in the PWID population in 2022.

Main Methods:

• Analysis of data from the National HIV Behavioral Surveillance (NHBS) survey cycles in 2018 and 2022.
• Comparison of PrEP awareness, access, and use between 2018 and 2022 using chi-squared tests.
• Poisson regression analysis to assess changes in PrEP awareness and identify associated factors in 2022.

Main Results:

• PrEP awareness significantly increased from 17% in 2018 to 33% in 2022 (aPR=1.24).
• No significant changes were observed in PrEP access or use between 2018 and 2022.
• In 2022, PrEP awareness was higher among Hispanic individuals and those with prior drug treatment compared to white, non-Hispanic PWID.

Conclusions:

• While PrEP awareness has improved among PWID, this has not translated into increased access or utilization.
• Current levels of PrEP use among PWID are insufficient to achieve national HIV prevention goals, such as those outlined in the Ending the HIV Epidemic initiative.
• Targeted interventions are needed to improve PrEP access and uptake among people who inject drugs.