https://orcid.org/0000-0001-5735-385X
Abstract
Background
Women with substance use disorders (SUDs) are a key population for HIV prevention with pre-exposure prophylaxis (PrEP), though uptake is limited by awareness of PrEP, misestimation of personal HIV risk, and minimally integrated HIV prevention and addiction treatment services. Patient-centered decision aids (DA) could address these barriers to PrEP, but no extant DA for PrEP has been published, including for women with SUDs.
Methods
We developed a patient-centered PrEP DA for women in addiction treatment. In a pilot randomized preference trial, we compared the DA to enhanced standard of care (eSOC) providing standardized information. The primary outcome was opting to receive more information through the DA; we also assessed the impact of the DA on PrEP decisional preference and PrEP uptake over 12 months.
Results
A total of 164 enrolled participants (DA: 83; eSOC: 81) were similar in terms of HIV risk and demographics, which are representative of women in addiction treatment programs nationally, and most (92%) had opioid use disorder. Half of participants were PrEP eligible, though 37% underestimated their personal HIV risk. Independent correlates of selecting the PrEP DA relative to eSOC included higher alcohol use severity (aOR 4.13, 95% CI 1.05–16.28, p=0.04) and perception of high risk for HIV (aOR 2.95, 95% CI 1.19–7.35, p=0.02). For those selecting the DA, interest in PrEP increased significantly from 25% to 89%. DA participants were also significantly more likely than eSOC participants to see a provider for PrEP during follow-up (15.7% vs 6.2%; p=0.05).
Conclusion
Half of the women selected to use the DA, and those who did significantly increased their engagement in the HIV prevention cascade through increased interest in and initiation of PrEP. Future iterations should accelerate the HIV prevention cascade for women with SUDs by integrating PrEP decision aids into existing addiction treatment services and actively linking women to PrEP.
Data Sharing Statement
De-identified participant data are available upon reasonable request to the corresponding author, within 5 years of publication.
Disclosure
Dr Jaimie Meyer reports grants from Gilead Sciences, Inc., outside the submitted work. Dr Glyn Elwyn reports personal fees from EBSCO, during the conduct of the study. Dr Frederick Altice reports grants from NIH, NIDA, SAMHSA, HRSA, Merck, Gilead; also an advisory Board member for Gilead Science, Merck Pharmaceuticals, AbbVie, Alliance for Patient Access; and received Honoraria for speakers bureau from Practice Point Communications, Clinical Care Options, Gilead Science, outside the submitted work. The authors report no other conflicts of interest in this work.