Refining a Community-Based Strategy to Engage Difficult to Reach Populations in PrEP Care

Project Summary:

New HIV diagnoses have increased by more than 35% in Wisconsin over the past five years. While PrEP is a highly effective means of HIV prevention, uptake remains limited among individuals whose HIV risk is tied to highly stigmatized behaviors such as sex work and injection drug use. In fact, as few as 7% of sex workers (SW) and 5.9% of persons who inject drugs (PWID) have ever spoken to a healthcare provider regarding PrEP, and an even smaller percentage successfully initiate treatment. The best available data suggests that more than 100,000 PWID and 17,000 SW reside in the state of Wisconsin. Thus, if we are to reduce the burden of HIV in Wisconsin, interventions tailored to the unique needs of these historically difficult to reach populations (HDR) are of critical importance. Most PrEP care is delivered in traditional outpatient clinics that require regularly scheduled in-person visits for testing and prescription refills. Such settings may be undesirable or inaccessible for HDR populations due to stigma, lack of transportation, or geographic inaccessibility (i.e. rural location). In addition, reliable medication storage and daily pill adherence may be challenging for individuals who use drugs or are experiencing housing instability, reducing the efficacy of oral PrEP. This project seeks to first understand barriers and facilitators to PrEP uptake in HDR populations by engaging community-based service providers throughout the state of Wisconsin. Building on the insights gathered in this process, the project team will then refine and implement a low barrier Tele-PrEP care delivery model within community centers serving HDR individuals including access to new, long-acting injectable PrEP (LAI-PrEP) formulations. This work will serve as the foundation for a subsequent R01 grant proposal, aligned with current NIH prioritization of implementation science work in the field of HIV prevention, specifically focusing on LAI-PrEP.