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Do People Who Inject Drugs Use HIV PrEP?

HIV PrEP prescriptions increased from 0 among people who use injection drugs, but overall PrEP uptake remains low.

Though it is highly effective at preventing HIV infection, pre-exposure prophylaxis (PrEP) is underutilized among injection drug users. Thus, investigators from the Boston University School of Medicine and Boston Medical Center sought to determine the prevalence of HIV PrEP among commercially insured individuals who use injection drugs.

The cross-sectional study, published in JAMA, included 547709 commercially insured persons with opioid and/or stimulant use disorder. Data were analyzed from November 1, 2020-July 1, 2021. Of the cohort, 110592 had evidence of injection drug use (IDU) between January 1, 2010-December 31, 2019.

The primary study outcome was receipt of PrEP (tenofovir disoproxil fumarate and emtricitabine) as determined by pharmacy claims. The investigators used multivariable logistic regression to assess the association of clinical and demographic characteristics with PrEP use.

Of the 547709 participants, the average age was 34.8 years and 61.4% were male. During the study period, PrEP was prescribed to 0.09% of the overall study population (n = 508), and to 0.15% of those with evidence of IDU (n = 170).

From 2010 to 2019, PrEP prescriptions increased from 0.001 to 0.243 per 100 person-years among the study population, and 0.000 to 0.295 per 100 person-years among those with IDU.

After conducting multivariable analysis, the investigators found PrEP use was more likely among males, people with IDU evidence, and people with evidence of sexual risk indicating them for PrEP.

The investigators concluded that HIV PrEP prescriptions remained low among commercially insured persons with opioid and/or stimulant use disorders. They emphasized that PrEP should be consistently offered to anyone receiving substance use disorder treatment, harm reduction, or HIV prevention services.