Expansion of Preexposure Prophylaxis Capacity in Response to an HIV Outbreak Among People Who Inject Drugs-Cabell County, West Virginia, 2019

Abstract

From January 1, 2018, through October 9, 2019, 82 HIV diagnoses occurred among people who inject drugs (PWID) in Cabell County, West Virginia. Increasing the use of HIV preexposure prophylaxis (PrEP) among PWID was one of the goals of a joint federal, state, and local response to this HIV outbreak. Through partnerships with the local health department, a federally qualified health center, and an academic medical system, we integrated PrEP into medication-assisted treatment, syringe services program, and primary health care settings. During the initial PrEP implementation period (April 18-May 17, 2019), 110 health care providers and administrators received PrEP training, the number of clinics offering PrEP increased from 2 to 15, and PrEP referrals were integrated with partner services, outreach, and testing activities. The number of people on PrEP increased from 15 in the 6 months before PrEP expansion to 127 in the 6 months after PrEP implementation. Lessons learned included the importance of implementing PrEP within existing health care services, integrating PrEP with other HIV prevention response activities, adapting training and material to fit the local context, and customizing care to meet the needs of PWID. The delivery of PrEP to PWID is challenging but complements other HIV prevention interventions. The expansion of PrEP in response to this HIV outbreak in Cabell County provides a framework for expanding PrEP in other outbreak and non-outbreak settings.

Keywords: HIV; implementation; outbreak response; people who inject drugs; preexposure prophylaxis.

Figure.

Summary of implementation of PrEP expansion framework and outcomes, Cabell County, West Virginia, 2019. (+) indicates a favorable determinant, (–) indicates an unfavorable determinant, and (+/−) indicates a mixed determinant of PrEP expansion. The preimplementation period was November 1, 2018, through April 30, 2019. The postimplementation period was May 1 through October 31, 2019. Abbreviations: CHHD, Cabell-Huntington Health Department; HD, health department; MAT, medication-assisted treatment; PrEP, preexposure prophylaxis; PWID, people who inject drugs; SSP, syringe services program.