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. 2025 Jul 3;12(7):ofaf389.
doi: 10.1093/ofid/ofaf389. eCollection 2025 Jul.

Willingness to Take Long-Acting Injectable Preexposure Prophylaxis (PrEP) and Preference for PrEP Modalities Among People Who Inject Drugs in Washington, DC

Xinyi Li  1 , Sydney Bornstein  1 , Madhu Balachandran  1 , Manya Magnus  1 , Kate Drezner  2 , Brittani Saafir-Callaway  2 , Irene Kuo  1
Affiliations

Willingness to Take Long-Acting Injectable Preexposure Prophylaxis (PrEP) and Preference for PrEP Modalities Among People Who Inject Drugs in Washington, DC

Xinyi Li et al. Open Forum Infect Dis. .

Abstract

Background: People who inject drugs (PWID) face multilevel barriers to adhering to daily oral preexposure prophylaxis (PrEP). Long-acting injectable (LAI) PrEP may help overcome some of these barriers. Understanding willingness among PWID to take LAI PrEP and preferences for PrEP modality is important to promote LAI PrEP when it becomes available to them.

Methods: We analyzed data from the 2018 National HIV Behavioral Surveillance PWID data collection cycle in Washington, DC. Respondent-driven sampling weighted proportions and correlates of willingness to take LAI PrEP and preference for LAI PrEP versus daily oral PrEP were reported, overall and stratified by gender.

Results: Of 402 PWID, 69.1% reported being extremely likely/likely to take LAI PrEP; 52.4% preferred LAI PrEP over daily oral PrEP. Being female and uninsured were associated with higher odds of willingness to take LAI PrEP. Having no/low income and past-year sexual violence were associated with preferring LAI PrEP over daily oral PrEP. Men who inject drugs who were aware of PrEP had higher odds to prefer LAI PrEP over daily oral PrEP. Women who inject drugs (WWID) reporting no/low income, sexual violence, and receptive needle sharing were more likely to prefer LAI PrEP over daily oral PrEP.

Conclusions: PWID in Washington, DC reported high willingness to take LAI PrEP; half reported preferring LAI PrEP. Improving education about PrEP is important for healthcare providers and PWID. Subgroups of WWID experiencing sexual violence may benefit from LAI PrEP. Human immunodeficiency virus prevention programs for PWID should consider gender differences when implementing LAI PrEP.

Keywords: long-acting injectable PrEP; people who inject drugs; willingness.

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