title: Correlates of willingness to initiate pre-exposure prophylaxis and anticipation of practicing safer drug- and sex-related behaviors among high-risk drug users on methadone treatment.
abstract: Although people who use drugs (PWUD) are key populations recommended to receive pre-exposure prophylaxis (PrEP) to prevent HIV, few data are available to guide PrEP delivery in this underserved group. We therefore examined the willingness to initiate PrEP and the anticipation of HIV risk reduction while on PrEP among high-risk PWUD.
  
  
  
  In a cross-sectional study of 400 HIV-negative, opioid dependent persons enrolled in a methadone program and reporting recent risk behaviors, we examined independent correlates of being willing to initiate PrEP.
  
  
  
  While only 72 (18%) were aware of PrEP, after being given a description of it, 251 (62.7%) were willing to initiate PrEP. This outcome was associated with having neurocognitive impairment (aOR=3.184, p=0.004) and higher perceived HIV risk (aOR=8.044, p<0.001). Among those willing to initiate PrEP, only 12.5% and 28.2%, respectively, indicated that they would always use condoms and not share injection equipment while on PrEP. Consistent condom use was associated with higher income (aOR=8.315, p=0.016), always using condoms with casual partners (aOR=6.597, p=0.001), and inversely associated with ongoing drug injection (aOR=0.323, p=0.027). Consistent safe injection, however, was inversely associated with age (aOR=0.948, p=0.035), ongoing drug injection (aOR=0.342, p<0.001), and perceived HIV risk (aOR=0.191, p=0.019).
  
  
  
  While willingness to initiate PrEP was high and correlated with being at elevated risk for HIV, anticipated higher risk behaviors in this group even while on PrEP suggests that the next generation of HIV prevention approaches may need to combine biomedical and behavioral components to sustain HIV risk reduction over time.
authors.affiliation: Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington, CT, USA; Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA. Electronic address: Roman.Shrestha@UConn.edu.
authors.forename: Roman
authors.initials: R
authors.lastname: Shrestha
authors.affiliation: Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA; Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA.
authors.forename: Pramila
authors.initials: P
authors.lastname: Karki
authors.affiliation: Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA; Department of Internal Medicine, AIDS Program, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Altice
authors.affiliation: Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA; Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA.
authors.forename: Tania B
authors.initials: TB
authors.lastname: Huedo-Medina
authors.affiliation: Department of Internal Medicine, AIDS Program, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Jaimie P
authors.initials: JP
authors.lastname: Meyer
authors.affiliation: APT Foundation, New Haven, CT, USA.
authors.forename: Lynn
authors.initials: L
authors.lastname: Madden
authors.affiliation: Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA; Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Copenhaver
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology* / Q000635:transmission; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D009042:Motivation; D016485:Needle Sharing / Q000523:psychology*; D009293:Opioid-Related Disorders / Q000523:psychology* / Q000534:rehabilitation*; D065129:Pre-Exposure Prophylaxis; D040242:Risk Reduction Behavior; D012725:Sexual Behavior; D013223:Statistics as Topic; D015819:Substance Abuse, Intravenous / Q000523:psychology* / Q000534:rehabilitation*; D047568:Unsafe Sex / Q000523:psychology*
chemical_list: D008691:Methadone
keywords: HIV prevention; Methadone maintenance program; People who use drugs (PWUD); Pre-exposure prophylaxis; Risk compensation; Substance use