Suboptimal Uptake, Retention, and Adherence of Daily Oral Prexposure Prophylaxis Among People With Opioid Use Disorder Receiving Hepatitis C Virus Treatment

Christopher Brokus; Sarah Kattakuzhy; Britt Gayle; Shivakumar Narayanan; Ashley Davis; Amelia Cover; Rahwa Eyasu; Emade Ebah; Onyinyechi Ogbumbadiugha-Weekes; Jennifer Hoffmann; Rachel Silk; Jasmine Stevens; Julia Mount; Catherine Gannon; Laura Nussdorf; Poonam Mathur; Phyllis Bijole; Miriam Jones; Randy Kier; David Sternberg; Aaron Greenblatt; Eric Weintraub; Henry Masur; Shyamasundaran Kottilil; Elana Rosenthal

doi:10.1093/ofid/ofab658

Suboptimal Uptake, Retention, and Adherence of Daily Oral Prexposure Prophylaxis Among People With Opioid Use Disorder Receiving Hepatitis C Virus Treatment

Open Forum Infect Dis. 2021 Dec 29;9(3):ofab658. doi: 10.1093/ofid/ofab658. eCollection 2022 Mar.

Authors

Christopher Brokus^{1

2}, Sarah Kattakuzhy^{1

2}, Britt Gayle^{1

2}, Shivakumar Narayanan², Ashley Davis^{1

2}, Amelia Cover^{1

2}, Rahwa Eyasu^{1

2}, Emade Ebah^{1

2}, Onyinyechi Ogbumbadiugha-Weekes^{1

2}, Jennifer Hoffmann², Rachel Silk^{1

2}, Jasmine Stevens^{1

3}, Julia Mount^{1

3}, Catherine Gannon^{1

3}, Laura Nussdorf¹, Poonam Mathur², Phyllis Bijole⁴, Miriam Jones⁴, Randy Kier⁴, David Sternberg⁴, Aaron Greenblatt^{5

6}, Eric Weintraub⁵, Henry Masur^{1

3}, Shyamasundaran Kottilil^{1

2}, Elana Rosenthal^{1

2}

Affiliations

¹ DC Partnership for HIV/AIDS Progress, Washington, District of Columbia, USA.
² Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
³ Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
⁴ HIPS, Washington, District of Columbia, USA.
⁵ Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA.
⁶ Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.

Abstract

Background: Daily oral preexposure prophylaxis (PrEP) with tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) prevents human immunodeficiency (HIV) among people who inject drugs (PWID). Despite rising HIV incidence and injection drug use (IDU), PrEP use remains low and there is limited research about uptake, adherence, and retention among PWID.

Methods: The ANCHOR investigation evaluated a community-based care model collocating hepatitis C virus (HCV) treatment, medication for opioid use disorder (OUD), and PrEP in individuals in Washington, DC, and Baltimore, Maryland. PrEP counseling was conducted from HCV treatment day 0 until week 24. Subjects could start any time during this window, were followed for 48 weeks, and were assessed for adherence by self-report and dried blood spot TDF analysis.

Results: One hundred ninety-eight participants were enrolled, of whom 185 (93%) were HIV negative. Twenty-nine individuals (15.7% of HIV-negative cohort) initiated PrEP. One hundred sixteen participants (62.7%) met 2014 Centers for Disease Control and Prevention (CDC) PrEP criteria due to IDU (82 [44.3%]), sex (9 [4.9%]), or both practices (25 [13.5%]). Providers recommended PrEP to 94 individuals (50.8%), and recommendation was associated with PrEP uptake. Median treatment duration was 104 days (interquartile range, 28-276 days), with 8 participants retained through week 48. Adherence was variable over time by self-report and declined by TDF analysis. No HIV seroconversions occurred.

Conclusions: This cohort of people with HCV and OUD experienced low uptake of PrEP despite the majority meeting CDC criteria. High rates of disruption and discontinuation, compounded by variable adherence, made TDF/FTC a suboptimal prevention strategy. Emerging modalities like long-acting formulations may address these barriers, but PWID have been excluded from their development to date.

Keywords: HCV; OUD; PWID; PrEP; opioid use disorder.

Grants and funding

K12 HL143886/HL/NHLBI NIH HHS/United States