Evidence from recent pre-exposure prophylaxis (PrEP) trials has demonstrated its safety and efficacy in significantly reducing the risk of HIV acquisition for those who are at considerable risk of acquiring HIV infection. With a rapid increase in the amount of research on the efficacy of PrEP for HIV prevention, complementary research on the willingness to use PrEP has grown, especially among MSM, but limited research has been focused among people who use drugs (PWUD). As part of the formative process, we utilized the information-motivation-behavioral skills (IMB) model of health behavior change to characterize and guide intervention development for promoting willingness to use PrEP among high-risk PWUD. The analysis included 400 HIV-negative high-risk PWUD enrolled in a community-based methadone maintenance treatment who reported drug- and/or sex-related HIV risk behaviors in the past 6-months. Analyses revealed support for the IMB model as PrEP-related behavioral skills were found to mediate the influence of PrEP-related information and motivation on willingness to use PrEP. The results provide evidence as to the utility of the IMB model to increase willingness to use PrEP among high-risk PWUD. It therefore makes an important contribution to our understanding of the applicability of theoretically-grounded models of willingness to use PrEP among high-risk PWUD, who are one of the key risk populations who could benefit from the use of PrEP.
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This work was supported by grants from the National Institute on Drug Abuse for research (R01 DA025943 to FLA) and for career development (K24 DA017072 to FLA; K02 DA033139 to MMC).
Conflicts of interest
The authors have no conflicts of interest to disclose.
The study protocol was approved by the Investigational Review Board (IRB) at the University of Connecticut and received board approval from APT Foundation Inc. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Brief description of pre-exposure prophylaxis (PrEP) provided to the participants.
“There is a new way to prevent HIV infection for people who may be exposed to the virus. It is called Pre-Exposure Prophylaxis or PrEP. It involves an HIV-negative person taking a pill daily, on an ongoing basis (starting before an exposure and continuing after for as long as the person is at risk) to reduce their risk of HIV infection. Research suggests that PrEP is generally safe and is highly effective (over 90%) in preventing HIV infection if taken every day. It is much less effective if not taken every day and does not protect against other sexually transmitted infections. Taking PrEP would require a visit to a doctor every three months in order to be tested for HIV, STIs and side effects.”
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Shrestha, R., Altice, F.L., Huedo-Medina, T.B. et al. Willingness to Use Pre-Exposure Prophylaxis (PrEP): An Empirical Test of the Information-Motivation-Behavioral Skills (IMB) Model among High-Risk Drug Users in Treatment. AIDS Behav 21, 1299–1308 (2017). https://doi.org/10.1007/s10461-016-1650-0
- Pre-exposure prophylaxis
- People who use drugs
- Substance use
- IMB model
- Structural equation modeling