JMIR Publications

ABSTRACT

Background:

HIV prevalence among people who use drugs (PWUD) in Baltimore, Maryland, is higher than among the general population. Pre-exposure prophylaxis (PrEP) is a widely available medication that prevents HIV transmission, yet is underutilized by PWUD in Baltimore City and the US. Community-level interventions to promote PrEP uptake and adherence among PWUD are limited.

Objective:

We describe the development of a capacity-strengthening intervention designed for frontline harm reduction workers (FHRW) to support PrEP awareness-building and promotion among PWUD.

Methods:

Our study was implemented in two phases in Baltimore City, Maryland. The formative phase focused on a qualitative exploration of the PrEP implementation environment, as well as facilitators and barriers to PrEP willingness and uptake, among cisgender women who use drugs. This work, as well as existing literature, theory, and feedback from our community partners, informed the intervention development phase, which used an academic-community partnership model. The intervention involved a one-time, 2-hour training with FHRW, aimed at increasing general PrEP knowledge and developing self-efficacy promoting PrEP in practice (e.g., facilitating PrEP dialogues with clients, supporting client advancement along a model of PrEP readiness, referring clients to PrEP services). In a future paper, we will describe the conduct and results of a mixed methods evaluation to assess changes in PrEP-related knowledge, attitudes, self-efficacy, and promotion practices among FHRW participating in the training.

Results:

The pilot was developed from October-December 2021 and implemented from December 2021 through April 2022. We leveraged existing relationships with community-based harm reduction organizations to recruit FHRW into the intervention. Thirty-nine FHRW from 4 community-based organizations participated in the training across 4 sessions (1 in-person, 2 online synchronous, and 1 online asynchronous). FHRW training attendees represented a diverse range of work cadres, including peer workers, case managers, and organizational administrators.

Conclusions:

This intervention, if effective, could prevent HIV burden among PWUD by leveraging the relationships that FHRW have with PWUD and supporting advancement along the PrEP continuum. Given suboptimal PrEP uptake among PWUD, and the limited number of interventions designed to address this gap, our intervention offers an innovative approach to a burgeoning public health problem. If effective, our intervention has the potential to be further developed and scaled up to increase PrEP awareness and uptake among PWUD around the globe. Clinical Trial: NA