Intention to initiate and uptake of PrEP among women who injects drugs in a demonstration project: an application of the theory of planned behavior

ABSTRACT

Some women who inject drugs (WWID) would benefit from pre-exposure prophylaxis (PrEP), yet there are few studies of issues related to uptake in real-world settings. In this study, participants (n = 95) were offered PrEP and responded to items measuring PrEP-related attitudes, norms, and perceived behavioral control based on the Theory of Planned Behavior. We tested associations with intention to initiate PrEP and uptake. Most WWID (88%) intended to initiate PrEP and 78% accepted a prescription. Compared to WWID who did not express PrEP intentions, those who did were less concerned about attitudinal and perceived behavioral control constructs such as temporary (75% vs. 36%, p = 0.01) and long-term (63% vs. 27%, p = 0.05) side effects, negative interactions with their birth control (93% vs. 38%, p < 0.01), their ability to take a daily pill (80% vs. 36%, p < 0.01), and the cost of PrEP (87% vs. 36%, p < 0.01). WWID who went on to take PrEP had fewer concerns with subjective norms constructs such as talking to health care providers about sex (91% vs. 65%, p < 0.01) and drug use (88% vs. 55%, p < 0.01) compared to those who did not. Attitudes and perceived behavioral control influenced intention while subjective norms had a greater impact on actual uptake.

KEYWORDS:

• Theory of planned behavior
• women who inject drugs
• HIV prevention
• pre-exposure prophylaxis

Acknowledgements

The authors would like to acknowledge the participants, community advisory board, research assistants and the staff at Prevention Point Philadelphia for their support in conducting this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The primary data that support the findings of this study is not publicly available due to IRB restrictions as they contain information that could compromise the privacy of research participants.

Additional information

Funding

This work is supported by the National Institute on Drug Abuse under Grant R21DA043417-02 and the American Sexually Transmitted Diseases Association Developmental Award.