Advancing pre-exposure prophylaxis (PrEP) implementation for people who use drugs: an introduction to and lessons from the special series

Persistent, multilevel barriers to PrEP accessAcross this special series, papers provided rich qualitative and quantitative evidence with some emerging themes that add to existing literature on persistent, multilevel barriers to PrEP access and uptake across populations of PWUD.First, at the individual level, several studies confirmed low PrEP awareness and perceived need as challenges to PrEP uptake for PWUD.For example, Eger et al. 's analysis of data collected from people who inject drugs (PWID) in San Diego, CA, found that an astounding 75% of participants had never heard of PrEP over a decade after it was approved for use in the United States.Nevertheless, preferences were strongest for long-acting formulations, confirming that regardless of awareness, daily oral PrEP could pose challenges to initial and sustained engagement [1].Similarly, Fletcher et al. surveyed U.S. veterans with unhealthy alcohol use and found low PrEP awareness and willingness, including among those experiencing high risk of alcohol-related harms [2].In Uganda, Kamusiime et al. interviewed PWID accessing harm reduction services and found that, despite awareness of behaviors that elevated their HIV risk (e.g., sharing syringes, transactional sex), many study participants prioritized daily survival needs over initiating PrEP [3].