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Strategies to Improve PrEP Adherence in People Who Use Drugs: A Systematic Review
Janae Briggs1, John Chiosi2,3,4, Sirisha Papineni5
1Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA.
AIDS and Behavior
|September 28, 2025
Summary
Pre-exposure prophylaxis (PrEP) can prevent HIV among people who use drugs (PWUD), but adherence is key. Successful strategies address cost, access, and integrate with opioid treatment, improving HIV prevention for this population.
Area of Science:
- Public Health
- Infectious Disease Prevention
- Substance Use Disorders
Background:
- People who use drugs (PWUD) have a high risk of HIV infection.
- Pre-exposure prophylaxis (PrEP) is effective but requires adherence for success.
Purpose of the Study:
- To systematically review PrEP interventions for PWUD.
- To identify strategies that enhance PrEP adherence in this population.
Main Methods:
- Systematic review following PRISMA guidelines.
- Searched EMBASE, PubMed, and ClinicalTrials.gov.
- Included nine studies examining PrEP interventions for PWUD.
Main Results:
- Interventions varied widely; successful ones reduced costs and improved access.
- Digital tools and integration with opioid substitution therapy (OST) showed promise.
- High adherence (80-95%) seen when PrEP combined with OST or medication for opioid use disorder.
- Behavioral interventions were underutilized.
- Women who use drugs face unique barriers requiring tailored support.
Conclusions:
- Targeted PrEP interventions addressing financial and logistical barriers are crucial for PWUD.
- Combining PrEP with OST or medication for opioid use disorder significantly improves adherence.
- Further research is needed, especially on tailored, trauma-informed care for women who use drugs.
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