Pharmacy PEP Access Intervention Among Persons Who Use Drugs in New York City: iPEPcare Study—Rethinking Biomedical HIV Prevention Strategies
Biomedical HIV prevention uptake has not taken hold among Black and Latinx populations who use street-marketed drugs. A pilot intervention providing a PEP informational video and direct pharmacy access to a PEP starter dose was conducted among this population. Four study pharmacies were selected to help facilitate syringe customer recruitment (2012–2016). Baseline, post-video, and 3-month ACASI captured demographic, risk behavior, and psychosocial factors associated with PEP willingness, and willingness to access PEP in a pharmacy. A non-experimental study design revealed baseline PEP willingness to be associated with PEP awareness, health insurance, being female, and having a high-risk partner (n = 454). Three-month PEP willingness was associated with lower HIV stigma (APR = 0.95). Using a pre-post approach, PEP knowledge (p < 0.001) and willingness (p < 0.001) increased overtime; however, only three participants requested PEP during the study. In-depth interviews (n = 15) identified lack of a deeper understanding of PEP, and contextualized perceptions of HIV risk as PEP access barriers. Pharmacy PEP access shows promise but further research on perceived risk and HIV stigma is warranted.
KeywordsPEP Drug use Pharmacy Structural intervention Mixed-methods
We would like to thank the study participants for sharing their experiences, and the study staff for their hard work. This research was sponsored by the National Institute on Drug Abuse, R01DA030253. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the funders.
- 2.Tsai CC, Emau P, Follis KE, et al. Effectiveness of postinoculation (R)-9-(2-phosphonylmethoxypropyl) adenine treatment for prevention of persistent simian immunodeficiency virus SIVmne infection depends critically on timing of initiation and duration of treatment. J Virol. 1998;72(5):4265–73.CrossRefGoogle Scholar
- 3.Cardo DM, Culver DH, Ciesielski CA, et al. A case–control study of HIV seroconversion in health care workers after percutaneous exposure. Centers for Disease Control and Prevention Needlestick Surveillance Group. N Engl J Med. 1997;337(21):1485–1490. https://doi.org/10.1056/NEJM199711203372101 CrossRefPubMedGoogle Scholar
- 5.Landovitz RJ, Fletcher JB, Inzhakova G, Lake JE, Shoptaw S, Reback CJ. A novel combination HIV prevention strategy: post-exposure prophylaxis with contingency management for substance abuse treatment among methamphetamine-using men who have sex with men. AIDS Patient Care STDS. 2012;26(6):320–8. https://doi.org/10.1089/apc.2011.0432 CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Smith DK, Grohskopf LA, Black RJ, et al. Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States: recommendations from the U.S. Department of Health and Human Services. MMWR Recomm Rep. 2005;54(RR-2):1–20.PubMedGoogle Scholar
- 12.Donnell D, Mimiaga MJ, Mayer K, Chesney M, Koblin B, Coates T. Use of non-occupational post-exposure prophylaxis does not lead to an increase in high risk sex behaviors in men who have sex with men participating in the EXPLORE trial. AIDS Behav. 2010;14(5):1182–9. https://doi.org/10.1007/s10461-010-9712-1 CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Curtis KA, Kennedy MS, Luckay A, et al. Delayed maturation of antibody avidity but not seroconversion in Rhesus Macaques infected with simian HIV during oral pre-exposure prophylaxis. JAIDS J Acquir Immune Defic Syndr. 2011;57(5):355–62. https://doi.org/10.1097/QAI.0b013e3182234a51 CrossRefPubMedGoogle Scholar
- 21.Crawford ND, Amesty S, Rivera AV, Harripersaud K, Turner A, Fuller CM. Randomized, community-based pharmacy intervention to expand services beyond sale of sterile syringes to injection drug users in pharmacies in New York City. Am J Public Health. 2013;103(9):1579–82. https://doi.org/10.2105/AJPH.2012.301178 CrossRefPubMedPubMedCentralGoogle Scholar