Suboptimal HIV Pre-exposure Prophylaxis Awareness and Willingness to Use Among Women Who Use Drugs in the United States: A Systematic Review and Meta-analysis

  • Chen ZhangEmail author
  • James McMahon
  • Janie Simmons
  • L. Lauren Brown
  • Robertson Nash
  • Yu Liu
Substantive Review


In the United States (U.S.), more than 12 million women reported illicit drug use in the past month. Drug use has been linked to increased risk for HIV, but little is known about the uptake of HIV pre-exposure prophylaxis (PrEP) to prevent HIV among women who use drugs (WWUD). Following the PRISMA guideline, we conducted a multi-database literature search to assess engagement along the PrEP care continuum among WWUD in the U.S. Seven studies with a total of 755 women were included in the review: 370 (49%) Black, 126 (16.7%) Hispanics, and 259 (34.3%) Whites. Employing random-effect models, data indicate 20.6% (95% CI 8.7%, 32.4%) of WWUD were aware of PrEP, and 60.2% (95% CI 52.2%, 68.2%) of those aware were also willing to use PrEP. Notwithstanding study limitations, our findings suggest there may be potential to increase PrEP uptake among WWUD, but efforts must first concentrate on improving PrEP awareness among this population.


Women who use drugs Pre-exposure prophylaxis Systematic review Meta-analysis United States 


En los Estados Unidos (EE. UU.), más de 12 millones de mujeres reportaron el uso de drogas ilícitas en el último mes. El uso de drogas se ha relacionado con un mayor riesgo de contraer el VIH, pero se sabe poco sobre la aceptación de la profilaxis preexposición (PrEP) para prevenir el VIH entre las mujeres que consumen drogas (MQCD). Siguiendo la guía de PRISMA, realizamos una búsqueda bibliográfica en múltiples bases de datos para evaluar el compromiso a lo largo de la cascada de atención de PrEP entre MQCD en los EE. UU. Se incluyeron siete estudios con un total de 755 mujeres en la revisión: 370 (49%) afroamericanas, 126 (16,7%) hispanas y 259 (34,3%) blancas. Empleando modelos de efectos aleatorios, los datos indican que el 20,6% (IC 95% = 8,7%, 32,4%) de MQCD tenían conocimiento de la PrEP, y un impresionante 60,2% (IC 95% = 52,2%, 68,2%) de las informadas también estaban dispuestas a utilizer la PrEP. A pesar de las limitaciones del estudio, nuestros hallazgos sugieren que puede haber un potencial para aumentar la aceptación de PrEP entre MQCD, pero los esfuerzos deben concentrarse primero en mejorar la conciencia de PrEP entre esta población.

Palabras clave

Mujeres que usan drogas Profilaxis preexposición Revisión sistemática Metanálisis Estados Unidos 



The study was supported by the University of Rochester Center for AIDS Research (Grant No. P30AI078498) and School of Nursing at University of Rochester Medical Center. The content is solely the responsibility of the authors and does not necessarily represent the sponsor who had no role in the design or conduct of the study, the writing of this report, or its submission for publication.


The study was supported by the University of Rochester Center for AIDS Research (P30AI078498) and School of Nursing at University of Rochester Medical Center. The content is solely the responsibility of the authors and does not necessarily represent the sponsor who had no role in the design or conduct of the study, the writing of this report, or its submission for publication.

Supplementary material

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Supplementary material 3 (DOC 63 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.School of NursingUniversity of Rochester Medical CenterRochesterUSA
  2. 2.Department of Social & Behavioral Sciences, College of Global Public Health, New York UniversityNew York CityUSA
  3. 3.Nashville CARESNashvilleUSA
  4. 4.Infectious Diseases DivisionVanderbilt University Medical CenterNashvilleUSA
  5. 5.Vanderbilt Comprehensive Care ClinicNashvilleUSA
  6. 6.Division of Epidemiology, Department of Public Health Science, School of Medicine and DentistryUniversity of Rochester Medical CenterRochesterUSA

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