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High Prevalence of Indications for Pre-exposure Prophylaxis Among People Who Inject Drugs in Boston, Massachusetts

  • Joel J. Earlywine
    Affiliations
    From the Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts

    Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
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  • Angela R. Bazzi
    Correspondence
    Address correspondence to: Angela R. Bazzi, PhD, MPH, Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston MA 02118.
    Affiliations
    Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
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  • Katie B. Biello
    Affiliations
    Center for Health Promotion and Health Equity, Brown University, Providence, Rhode Island

    Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island

    Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island

    The Fenway Institute, Fenway Health, Boston, Massachusetts
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  • R. Monina Klevens
    Affiliations
    Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts
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Published:November 21, 2020DOI:https://doi.org/10.1016/j.amepre.2020.09.011

      Introduction

      In Massachusetts, recent outbreaks of HIV have been fueled by injection and sexual exposures among people who inject drugs. Understanding pre-exposure prophylaxis need, knowledge, and use among people who inject drugs will help inform and evaluate interventions.

      Methods

      In 2019, investigators analyzed 2018 National HIV Behavioral Surveillance data from people who inject drugs in Boston, MA, who met eligibility criteria. Proportions of people who inject drugs with U.S. Preventive Services Task Force–based pre-exposure prophylaxis indication were estimated by types of HIV acquisition risk in the past year: injection exposure only, sexual exposure only, and overlapping injection and sexual exposures. Investigators then evaluated pre-exposure prophylaxis awareness, conversations with healthcare providers about pre-exposure prophylaxis, and self-reported pre-exposure prophylaxis use among those with and without pre-exposure prophylaxis indications.

      Results

      The prevalence of pre-exposure prophylaxis indication was 92% overall (389/423), with 290 (69%) participants indicated for injection exposures only, 3 (<1%) indicated for sexual exposures only, and 96 (23%) indicated for both injection and sexual exposures. Among those indicated for pre-exposure prophylaxis (n=389), 152 (39%) reported being aware of pre-exposure prophylaxis, 41 (11%) had discussed pre-exposure prophylaxis with a healthcare provider, and 8 (2%) had used pre-exposure prophylaxis in the past year. There were no statistically significant differences between pre-exposure prophylaxis‒indicated and ‒nonindicated people who inject drugs with respect to pre-exposure prophylaxis awareness, discussion with a healthcare provider, and pre-exposure prophylaxis use.

      Conclusions

      Indication for pre-exposure prophylaxis was high, but awareness was low, conversations about pre-exposure prophylaxis with healthcare providers were uncommon, and pre-exposure prophylaxis use was extremely low. These findings highlight important areas for clinical and community-based interventions to improve pre-exposure prophylaxis uptake among and delivery to people who inject drugs.
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