A Longitudinal Analysis of PrEP Eligibility in Women With a History of Injection Drug Use

Pre-exposure prophylaxis (PrEP) is a critical strategy for HIV prevention in women who inject drugs (WWID); however, only 1%-2% of WWID use PrEP. We aim to characterize factors associated with longitudinal PrEP eligibility in women with a history of injection drug use to inform optimization of PrEP implementation strategies.

Women who did not have HIV and were participating in the AIDS Linked to the Intravenous Experience (ALIVE) Cohort between 2014 and 2020 were included. Data on sociodemographic characteristics, substance use, depressive symptoms, and HIV risk behaviors were collected at semiannual visits. PrEP-eligibility was defined as sex-related (>1 partner with condomless sex, partner with HIV or who injects drugs, transactional sex or sexually transmitted infection) or injection-related (sharing drug use equipment) in the past 6 months. Associations between individual factors and PrEP eligibility were estimated using unadjusted and adjusted logistic regression with generalized estimating equations.

Among 382 women, the average follow-up was 3.2 years, and 41% were PrEP-eligible. At baseline, among PrEP-eligible women, 89% met sex-related, 41% met injection-related, and 30% met both sex-related and injection-related criteria; women were eligible for PrEP during 58% of follow-up. Periods of PrEP-eligibility were longitudinally associated with younger age [adjusted odds ratio (95% CI): 0.92 (0.90-0.94)], recent incarceration [aOR=2.29 (1.17-4.50)], severe depression [aOR=1.31 (1.06-1.62)], and recent overdose [aOR=1.56 (1.07-2.28)].

PrEP implementation efforts that incorporate strategies to support the needs of women with recent incarceration, severe depression, and recent overdose have the potential to maximize outcomes for WWID.