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Long-acting Injectable PrEP Interest and General PrEP Awareness among People who Inject Drugs in the San Diego-Tijuana Border Metroplex

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Abstract

Long-acting injectable HIV pre-exposure prophylaxis (LAI-PrEP) could help overcome multilevel challenges to HIV prevention for people who inject drugs (PWID), including those in the binational San Diego-Tijuana metroplex. Yet, general PrEP awareness and interest in LAI-PrEP remain underexplored among PWID. From 2020 to 2021, 562 HIV-negative PWID in San Diego and Tijuana completed surveys assessing general PrEP awareness and interest in oral and LAI-PrEP. Modified Poisson regression examined factors associated with general PrEP awareness. Multinomial logistic regression assessed factors associated with interest in both oral and LAI-PrEP, oral PrEP only, LAI-PrEP only, or neither. General PrEP awareness was low (18%) and associated with experiencing unsheltered homelessness (adjusted prevalence ratio [APR] = 1.50, 95% confidence interval [CI]: 0.96–2.33), past 6-month fentanyl injection (APR = 1.53, 95% CI: 1.04–2.25), and transactional sex (APR = 1.71, 95% CI: 1.06–2.76). Interest in oral PrEP only was most common (44%), followed by LAI-PrEP only (25%) and neither (16%). Compared to the odds of being interested in LAI-PrEP only, the odds of being interested in oral PrEP only were lower among those who were stopped by police (AOR = 0.38, 95% CI: 0.22–0.65), reported past 6-month fentanyl injection (AOR = 0.33, 95% CI: 0.20–0.56), polydrug use (AOR = 0.48, 95% CI: 0.27–0.86), injecting multiple times daily (AOR = 0.26, 95% CI: 0.14–0.46), receptive syringe use (AOR = 0.30, 95% CI: 0.19–0.49), and higher perceived HIV risk (AOR = 0.24, 95% CI: 0.15–0.39). Interest in LAI-PrEP was more common among PWID reporting social and structural factors that could interfere with oral PrEP adherence, suggesting LAI-PrEP implementation could increase PrEP coverage among those most vulnerable to HIV.

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Data Availability

Data are available upon reasonable request to the Principal Investigator of La Frontera, Dr. Steffanie Strathdee (sstrathdee@health.ucsd.edu).

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Acknowledgements

The authors gratefully acknowledge the La Frontera study team and participants in the San Diego-Tijuana metroplex where data were collected. We also thank staff at Genayltye and Fluxergy, and the Center for AIDS Research at UC San Diego for assistance interpreting laboratory results.

Funding

This work was supported by the San Diego Center for AIDS Research (National Institute of Allergy and Infectious Diseases, grant P30AI036214) with additional support from the National Institute on Drug Abuse (grants R01DA049644-S1, R01DA049644-02S2, K01DA043412, 3K01DA043412-04S1, and T32DA023356), and the California HIV/AIDS Research Program (CHRP; grant OS17-SD001). The funders had no role in the decision to write and publish this manuscript or in the interpretation and presentation of findings.

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Authors and Affiliations

  1. School of Medicine, University of California, San Diego, La Jolla, CA, USA

    William H. Eger, Chad J. Valasek, Carlos F. Vera, Alicia Harvey-Vera, Irina Artamonova, Steffanie A. Strathdee & Heather A. Pines

  2. School of Social Work, San Diego State University, San Diego, CA, USA

    William H. Eger

  3. Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA

    Angela R. Bazzi & Heather A. Pines

  4. Boston University School of Public Health, Boston, MA, USA

    Angela R. Bazzi

  5. Mexico Section of the US-Mexico Border Health Commission, Tijuana, Baja California, Mexico

    M Gudelia Rangel

  6. Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA

    Heather A. Pines

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  1. William H. Eger
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Contributions

Conceptualization, Methodology, Funding acquisition: A.R.B., S.A.S., and H.A.P.; Data validation and curation: W.H.E., I.A., and H.A.P.; Data analysis: W.H.E. and H.A.P.; Original manuscript draft: W.H.E., A.R.B., H.A.P.; Resources and project administration: C.F.V., A.H.V., M.G.R., and S.A.S. All authors contributed to the interpretation of results, manuscript revisions, and approved the final manuscript.

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Correspondence to Heather A. Pines.

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Eger, W.H., Bazzi, A.R., Valasek, C.J. et al. Long-acting Injectable PrEP Interest and General PrEP Awareness among People who Inject Drugs in the San Diego-Tijuana Border Metroplex. AIDS Behav 28, 1650–1661 (2024). https://doi.org/10.1007/s10461-024-04285-3

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