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Published on: March 30, 2014
Nurse Practitioner-Led, Same-Day, Pre-exposure Prophylaxis Delivery Program for People Who Inject Drugs in the United
Kamal Gautam1,2,3,4,5,6,7,8,9,10,11,12, Kiran Paudel1,2,3,4,5,6,7,8,9,10,11,12, Frederick L Altice1,2,3,4,5,6,7,8,9,10,11,12
1Kamal Gautam, MPH, is a PhD Candidate, Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA.
A new nurse practitioner-led, same-day pre-exposure prophylaxis (PrEP) model showed high acceptability and feasibility for people who inject drugs. However, sustained PrEP uptake remains a challenge for HIV prevention.
Area of Science:
- Public Health
- Infectious Disease Prevention
- HIV/AIDS Research
Background:
- Pre-exposure prophylaxis (PrEP) is a key HIV prevention strategy.
- Suboptimal PrEP uptake is a significant barrier among people who inject drugs (PWID).
- Innovative delivery models are needed to improve PrEP access for PWID.
Purpose of the Study:
- To evaluate the feasibility, acceptability, and preliminary efficacy of a nurse practitioner-led, same-day PrEP model (iRaPID).
- To assess PrEP uptake and retention among HIV-seronegative PWID within a syringe services program.
Main Methods:
- Pilot randomized controlled trial with 44 HIV-seronegative PWID.
- Comparison between the iRaPID model and treatment-as-usual.
- Assessment of PrEP prescription fills, refills, and acceptability at 30- and 90-day follow-ups.
Main Results:
- Higher PrEP uptake at 30 days in the iRaPID group (OR: 5.40, p = .016).
- High acceptability of the iRaPID model (mean ratings 3.9 at 30 days, 4.2 at 90 days).
- PrEP uptake was not sustained at 90 days (OR: 0.19, p = .133); only 3 participants refilled prescriptions at both follow-ups.
Conclusions:
- Nurse practitioner-led, same-day PrEP delivery via syringe services programs is feasible and acceptable.
- Challenges exist in sustaining long-term PrEP adherence and refills within this population.
- Further research is needed to optimize PrEP delivery models for sustained engagement among PWID.
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