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Pharmacy PEP Access Intervention Among Persons Who Use Drugs in New York City: iPEPcare Study—Rethinking Biomedical HIV Prevention Strategies

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Pharmacy PEP Access Intervention Among Persons Who Use Drugs in New York City: iPEPcare Study—Rethinking Biomedical HIV Prevention Strategies

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Abstract

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.
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AIDS and Behavior (2020) 24:2101–2111
https://doi.org/10.1007/s10461-019-02775-3
ORIGINAL PAPER
Pharmacy PEP Access Intervention Among Persons Who Use Drugs
inNew York City: iPEPcare Study—Rethinking Biomedical HIV
Prevention Strategies
CrystalFullerLewis1,2· Helen‑MariaLekas1,2· AlexisRivera3· SharifaZ.Williams2· NatalieD.Crawford4·
RafaelE.Pérez‑Figueroa2· AdrianaM.Joseph2· SilviaAmesty5,6,7
Published online: 10 January 2020
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
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 knowl-
edge (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.
Keywords PEP· Drug use· Pharmacy· Structural intervention· Mixed-methods
Introduction
Biomedical HIV prevention for occupational exposure
has been available for nearly three decades. Post-exposure
prophylaxis (PEP) has been proven effective in preventing
HIV after sexual and needle-related exposures in animal [1,
2] and human studies [36] and consists of a HIV medica-
tions prescribed for daily use, over 28-days, and initiated
within 72h of exposure for best efficacy [79]. PEP efficacy
trials, conducted mostly among men who have sex with men
(MSM), have reported effectiveness in preventing HIV infec-
tion even in cases with less than 100% adherence [46], and
have shown to be a cost-effective HIV prevention method
[10, 11] with no evidence of increased high risk behavior
[6, 12, 13]. In 2012, the U.S. Food and Drug Administra-
tion approved the first use of a daily antiretroviral drug to
prevent HIV infection as pre-exposure prophylaxis (PrEP)
among persons at high risk for HIV. A recent review noted
that both continuous and intermittent PrEP use demonstrated
high efficacy in preventing HIV seroconversion among het-
erosexual women, heterosexual HIV-discordant couples, and
* Crystal Fuller Lewis
crystal.lewis@nyulangone.org
1 Department ofPsychiatry, New York University School
ofMedicine, One Park Avenue, 8th Fl, Rm 201, NewYork,
NY10016, USA
2 Division ofSocial Solutions andServices Research, Nathan
S. Kline Institute forPsychiatric Research, Orangeburg, NY,
USA
3 Department ofEpidemiology, Columbia University Mailman
School ofPublic Health, NewYork, NY, USA
4 Department ofBehavioral Sciences andHealth Education,
Emory University, Rollins School ofPublic Health, Atlanta,
GA, USA
5 Center forFamily andCommunity Medicine, College
ofPhysicians andSurgeons, Columbia University Medical
Center, NewYork, NY, USA
6 Center forGlobal andPopulation Health, College
ofPhysicians andSurgeons, Columbia University Medical
Center, NewYork, NY, USA
7 Department ofPopulation andFamily Health, Columbia
University Mailman School ofPublic Health, NewYork, NY,
USA
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Five studies reported using or adapting established stigma and stigma-related scales [50][51][52][53][54]. One of these studies among PWUD in New York City measured externalized stigma, which involved a 9-item scale of anticipated HIV shame and blame from the HIV Stigma Index 2.0 [53]. ...
... Five studies reported using or adapting established stigma and stigma-related scales [50][51][52][53][54]. One of these studies among PWUD in New York City measured externalized stigma, which involved a 9-item scale of anticipated HIV shame and blame from the HIV Stigma Index 2.0 [53]. PWUD also participated in qualitative interviews to identify internalized stigma towards accessing post-exposure prophylaxis (PEP). ...
... The most common stigma reduction strategies involved information-based and skills building approaches, including education to enhance knowledge on HIV or drug use or the effect of stigma manifestations on health and well-being (Table 2) [50,51,53,56,57,59,60,[62][63][64][65][66]. For example, in Vietnam, a randomized control trial of a multilevel PWID and HIV stigma reduction intervention was conducted to optimize HIV outcomes, including survival, among PWID [57]. ...
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