Integrating HIV pre-exposure prophylaxis with community-based syringe services for women who inject drugs: Results from the Project SHE demonstration study

INTRODUCTION:To guide future pre-exposure prophylaxis (PrEP) implementation for women who inject drugs (WWID), a population increasingly represented in new HIV cases in the United States, we present results from a demonstration project integrated within a syringe services program (SSP) in Philadelphia, Pennsylvania, USA. METHODS:WWID 18 years were educated about and offered 24 weeks of daily PrEP. Participants completed surveys and clinical assessments at baseline, week 1, 3, 12, and 24. We used descriptive statistics to estimate feasibility/acceptability, engagement in the care cascade, HIV/STI and pregnancy, issues of safety/tolerability, and preferences/satisfaction with PrEP services. Multivariable logistic regression with generalized estimating equations were used to identify factors associated with PrEP uptake and retention. RESULTS:We recruited 136 WWID. Of those, 95 were included in the final sample, and 63 accepted a PrEP prescription at week 1. Uptake was associated with greater baseline frequency of SSP access (aOR=1.85; 95% CI1.24, 2.77), inconsistent condom use (aOR=3.38; 95% CI1.07, 10.7), and experiencing sexual assault (aOR=5.89; 95% CI1.02, 33.9). 42/95 (44.2%) were retained at week 24. Retention was higher among women who reported more frequent baseline SSP access (aOR=1.46; 95% CI1.04, 2.24). Self-reported adherence was high, but discordant with urine-based quantification of tenofovir. Baseline STI prevalence was 17.9%, there were two HIV seroconversions, and one pregnancy. Safety/tolerability issues were uncommon, and acceptability/satisfaction was high. CONCLUSIONS:Integrating PrEP with SSP services is feasible and acceptable for WWID. This supports that daily PrEP is a viable prevention tool for this vulnerable population.