People with HCV and opioid use disorder have low PrEP uptake, adherence
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HIV PrEP uptake and adherence were low among a cohort of people with opioid use disorder who were undergoing treatment for hepatitis C virus, despite many of them meeting CDC criteria for PrEP use, according to a study.
“This study was a component of the ANCHOR investigation, which evaluated a community-based model of hepatitis C care for people who use drugs (PWUD) utilizing hepatitis C as an opportunity to reduce harm and improve health of PWUD,” Christopher Brokus, BS, of the DC Partnership for HIV/AIDS Progress in Washington D.C., told Healio.
Brokus said there have been few studies to date examining PrEP implementation and retention among PWUD.
“This component of the study was prompted by the lack of scholarship and thus sought to better understand eligibility, uptake, adherence, and retention of PWUD in PrEP care,” he said.
According to the study, the researchers conducted PrEP counseling from HCV treatment day 0 through week 24, during which participants could start at any time and would then be followed for 48 weeks. They assessed participants’ adherence through self-report and dried bloodspot tenofovir/emtricitabine (TDF/FTC) analysis.
Overall, the study enrolled 198 participants, of whom 185 (93%) were HIV negative. Only 16% initiated PrEP, even though 116 participants (62.7%) met the 2014 CDC PrEP criteria due to injection drug use (82, 44.3%), sex (nine, 4.9%) or both (25, 13.5%). PrEP was recommended by providers to 94 patients.
The researchers found that the median treatment duration was 104 days (interquartile range = 28-276), with eight study participants retained through week 48.
They reported that PrEP adherence was suboptimal by both self-report and TDF analysis, never reaching above 60% or 50%, respectively, at any point during the study.
“This cohort of PWUD with OUD and HCV experienced suboptimal rates of PrEP uptake, adherence, and retention despite a low-barrier, community-centered approach to PrEP delivery,” Brokus said. “While this may appear discouraging, our research should not be used as a justification to withhold this essential treatment for PWUD but rather should galvanize the medical community to further invest in research and strategies to make PrEP treatment more accessible for PWUD.”
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