Staff Perspectives on Implementation of Long-Acting Injectable Preexposure Prophylaxis at a Low-Barrier Syringe...

Area of Science:

• Public Health
• Infectious Disease Prevention
• Implementation Science

Background:

• Long-acting injectable cabotegravir (CAB-LA) offers a novel pre-exposure prophylaxis (PrEP) strategy for HIV prevention.
• People who inject drugs (PWID) experience disproportionately high HIV risks and face significant barriers accessing care.
• The integration of CAB-LA into syringe services programs (SSPs), designed for low-barrier access, remains underexplored.

Purpose of the Study:

• To examine the implementation facilitators and barriers of CAB-LA delivery within SSPs.
• To identify strategies for optimizing CAB-LA integration into existing HIV prevention services for PWID.

Main Methods:

• Conducted semistructured interviews with 12 SSP staff members involved in CAB-LA delivery between August 2023 and July 2025.
• Employed thematic analysis guided by the Consolidated Framework for Implementation Research for interview data.
• Utilized qualitative data analysis to understand staff perspectives on CAB-LA implementation.

Main Results:

• Facilitators included CAB-LA's perceived advantages over oral PrEP, external support, pharmacy revenue, mission alignment, staff motivation, and financial incentives.
• Barriers comprised lack of FDA approval for PWID, complex logistics, performance pressures, infrastructure limitations, competing priorities, staff workload, and client engagement challenges.
• Staff identified key factors influencing the successful rollout of injectable PrEP.

Conclusions:

• Integrating CAB-LA into SSPs is a feasible and promising approach for HIV prevention among PWID.
• Successful implementation necessitates targeted strategies addressing identified barriers, including resource allocation, workflow adjustments, and enhanced client outreach.
• Further research and policy support are crucial for optimizing CAB-LA delivery in community-based settings.