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The Pre-exposure Prophylaxis (PrEP) Care Cascade in People Who Inject Drugs: A Systematic Review

AIDS and Behavior volume 25, pages 1490–1506 (2021)Cite this article

Abstract

Injection drug use is a key risk factor for the transmission of HIV. Prevention strategies, such as the use of pre-exposure prophylaxis (PrEP), are effective at reducing the risk of HIV transmission in people who inject drugs (PWID). Following PRISMA guidelines, a literature search was conducted to identify the current state of the PrEP care cascade in PWID. Twenty-three articles were evaluated in this systematic review. A decline in engagement throughout the stages of the PrEP care cascade was found. High awareness and willingness to use PrEP was found, yet PrEP uptake was relatively low (0–3%). There is a lack of research on interventions to increase engagement of PrEP across all levels of the care cascade in PWID. Implications from the interventions that have been published provide insight into practice and public policy on efficacious strategies to reduce HIV incidence in PWID. Our findings suggest that more efforts are needed to identify and screen PWID for PrEP eligibility and to link and maintain them with appropriate PrEP care.

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Funding

This work was supported by grants from the National Institute on Drug Abuse (K01DA051346 for RS and K24DA051344 for MMC) and grant from the National Institute of Mental Health (5T32MH074387-14 for CBM).

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Affiliations

  1. Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road, Unit 1101, Storrs, CT, 06269-1101, USA

    Colleen B. Mistler & Michael M. Copenhaver

  2. Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA

    Colleen B. Mistler, Michael M. Copenhaver & Roman Shrestha

  3. Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA

    Roman Shrestha

Authors
  1. Colleen B. Mistler
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  2. Michael M. Copenhaver
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  3. Roman Shrestha
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Correspondence to Colleen B. Mistler.

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Mistler, C.B., Copenhaver, M.M. & Shrestha, R. The Pre-exposure Prophylaxis (PrEP) Care Cascade in People Who Inject Drugs: A Systematic Review. AIDS Behav 25, 1490–1506 (2021). https://doi.org/10.1007/s10461-020-02988-x

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  • DOI: https://doi.org/10.1007/s10461-020-02988-x

Keywords

  • Pre-exposure prophylaxis (PrEP)
  • HIV prevention
  • People who inject drugs (PWID)
  • PrEP care cascade
  • Systematic review