"The Simplest Way to Go": An Exploration of Why Women Who Inject Drugs Chose Long-Acting Injectable Cabotegravir Instead of Daily Oral PrEP

Abstract

Long-acting injectable PrEP was approved for use in the US in 2021 but roll out has been slow, with few studies exploring uptake among cisgender women who inject drugs (WWID). We purposively recruited 25 WWID within 30-days of receiving a PrEP prescription from a low-barrier clinic co-located with a syringe services program to complete semi-structured interviews about PrEP product choice. We used an intersectional lens to compare decision-making between women choosing injectable PrEP versus oral PrEP and continued enrolling new participants until we reached thematic saturation (12/2022 to 2/2024). Participants represent a diverse sample of WWID (12 women of color) with median age 43 years. Daily injection drug use (72%) and ≥ 1 sex partner (64%) were common. Salient themes from interviews include: (1) PrEP provides women with a valued safety net and initiation is a form of self-preservation. (2) Co-located care, small incentives, and provider respect for WWID's medical autonomy helped participants navigate a multi-visit PrEP intake process. (3) Longer lasting HIV protection with less frequent dosing is preferrable to a shorter acting daily oral medication. When selecting a product, WWID evaluated its attributes against their medical history and personal circumstances like homelessness (64%). Most chose CAB-LA (72%) because it provides longer lasting protection which was a highly valued product attribute. Together, our findings underscore the critical importance of offering multiple PrEP options when implementing HIV prevention strategies that are patient-centered and responsive to the unique needs of WWID.

Keywords: Cabotegravir; Injection drug use; PrEP; Preferences; Women.