Shrestha Roman, Copenhaver Michael
Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States.
Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, CT, United States.
Front Public Health. 2018 Jul 13;6:195. doi: 10.3389/fpubh.2018.00195. eCollection 2018.
Despite unequivocal evidence supporting the use of pre-exposure prophylaxis (PrEP), its scale-up has been gradual overall, and nearly absent among people who use drugs (PWUD). In the present study, we implemented the use of PrEP, as a part of an integrated HIV prevention approach, and explored the experiences and attitudes related to PrEP use among PWUD. Between September 2016 and July 2017, we recruited 40 HIV-uninfected, methadone-maintained people, who reported HIV-risk behaviors, and were currently taking PrEP. We conducted both quantitative and in-depth semi-structured qualitative interviews that primarily focused on experiences, attitudes, acceptability, disclosure status, risk compensation-related attitudes, and barriers related to PrEP adherence. Results showed that participants were highly satisfied and perceived PrEP as valuable and acceptable for HIV prevention. Participants reported high adherence to PrEP. The most highly endorsed facilitators to PrEP adherence were use of memory aids, no out-of-pocket cost, perceived benefit, and support from social network. The barriers to adherence included side-effects, stigmatization, requirement of daily dosing, and accessibility of PrEP services. Additionally, participants expressed disagreement with the overall risk compensation-related attitudes (i.e., decreased personal concern about engaging in HIV risk behavior due to their perception that PrEP is now fully protecting them from contracting HIV) and indicated no increased engagement in risk behaviors while on PrEP. The results from the current study provide preliminary evidence supporting the successful integration of PrEP within the substance abuse treatment setting, where high risk PWUD are concentrated.
尽管有明确证据支持使用暴露前预防（PrEP），但其推广总体较为缓慢，在吸毒人群（PWUD）中几乎没有得到应用。在本研究中，我们将PrEP的使用作为综合HIV预防方法的一部分加以实施，并探讨了PWUD中与PrEP使用相关的经历和态度。在2016年9月至2017年7月期间，我们招募了40名未感染HIV、接受美沙酮维持治疗、报告有HIV风险行为且正在服用PrEP的人。我们进行了定量和深入的半结构化定性访谈，主要关注经历、态度、可接受性、披露情况、与风险补偿相关的态度以及与PrEP依从性相关的障碍。结果显示，参与者高度满意，并认为PrEP对预防HIV有价值且可接受。参与者报告对PrEP的依从性很高。对PrEP依从性最受认可的促进因素包括使用记忆辅助工具、无需自付费用、感知到的益处以及来自社交网络的支持。依从性的障碍包括副作用、污名化、每日服药的要求以及PrEP服务的可及性。此外，参与者对与风险补偿相关的总体态度表示不同意（即由于他们认为PrEP现在能完全保护他们不感染HIV，从而减少了对从事HIV风险行为的个人担忧），并表示在服用PrEP期间没有增加风险行为的参与度。本研究结果提供了初步证据，支持在高风险PWUD集中的药物滥用治疗环境中成功整合PrEP。
