Attitudes and Intentions toward Use of HIV Pre-Exposure Prophylaxis (PrEP) among Adults Receiving Treatment for Opioid Use

Abstract

Background: Although pre-exposure prophylaxis (PrEP) prevents HIV, little is known about PrEP awareness and factors associated with intention to take PrEP among people with opioid use disorder (OUD). Methods: HIV-negative adults recruited from an outpatient treatment program in Cincinnati, Ohio completed self-administered surveys. Items derived from literature and health behavioral theory included demographics, sexual and drug use behaviors, HIV prevention practices, PrEP knowledge, and attitudes toward PrEP. Primary outcomes were 1) intention to ask a clinician about PrEP and 2) intention to accept PrEP if recommended by a clinician. Outcomes were dichotomized into higher vs. lower intention for analyses in logistic regression models. Results: Among 198 participants, 60.3% reported past injection drug use. Among 58 participants (29.3%) meeting criteria for PrEP, 24% were aware of PrEP, 15.5% had discussed it with a clinician, and 5% had taken it. Factors associated with intention to ask a clinician about PrEP included being somewhat confident about consistent condom use (p < 0.01), motivation to comply with normative beliefs (p < 0.01), and reporting that PrEP fits very well (p < 0.01) and is easy to fit (p < 0.01) into current prevention practices. Factors associated with intention to accept PrEP if recommended by a clinician included motivation to comply with normative beliefs (p < 0.01) and PrEP being easy to fit into current prevention practices (p < 0.01). Conclusion: Among participants meeting indications for PrEP, only 24% were aware of it and few had taken it. Interventions that normalize PrEP and target incorporating PrEP into current prevention practices may improve uptake among individuals with OUD.

Keywords:

• Pre-exposure prophylaxis
• substance use
• attitudes
• survey
• HIV prevention
• opioid use disorder

Authors’ contributions

Tornia Wyllie interpreted the results and wrote the manuscript. Jennifer Brown conceived and designed the research and performed the research. Tanya L. Kowalczyk Mullins conceived and designed the research, performed the research, analyzed data, and wrote the manuscript. Andrea Meisman and Nadia Bayyari performed the research. Colleen Mangeot and Qin Sun analyzed the data. All authors contributed to the manuscript, approved submission of the final manuscript, and agree to be accountable for all aspects of the work.

Ethics approval

The questionnaire and methodology for this study was approved by the Institutional Review Board (IRB) of Cincinnati Children’s Hospital Medical Center (CCHMC) with a waiver of documentation of informed consent (2019-0913; approved 9/23/2019). The IRB at the University of Cincinnati provided IRB reliance on the CCHMC IRB.

Declaration of interest

Dr. Mullins received funding for an investigator initiated research project from Gilead Sciences, Inc.; this support was not received prior to or during the work described in this manuscript. Dr. Brown received funding for an investigator initiated research project from Gilead Sciences, Inc.; this support was not received prior to or during the work described in this manuscript.

Additional information

Funding

This work was supported by the Division of Adolescent and Transition Medicine Pilot Funds Award, Cincinnati Children’s Hospital Medical Center (PI: Mullins) The funder did not play a role in the work. REDCap (Research Electronic Data Capture) software was made available through the joint University of Cincinnati and Cincinnati Children’s Hospital Center for Clinical and Translational Science and Training, which is funded by the National Institutes of Health Clinical and Translational Science Award program, grant UL1TR001425.