Nurse Practitioner–Led, Same-Day, Pre-exposure Prophylaxis Delivery Program for People Who Inject Drugs in the United States: Findings From a Pilot Randomized Controlled Trial

ABSTRACT: Pre-exposure prophylaxis (PrEP) is effective for HIV prevention, yet uptake remains suboptimal among people who inject drugs. A pilot randomized controlled trial examined the feasibility, acceptability, and preliminary efficacy of a nurse practitioner-led, same-day PrEP model (iRaPID) within a syringe services program. Forty-four people who inject drugs who were HIV-seronegative were randomized 1:1 to iRaPID or treatment-as-usual. In iRaPID, 12 of 22 participants filled a PrEP prescription at baseline, including nine on the same day. Only three participants refilled prescriptions at both the 30- and 90-day follow-ups. Acceptability was high (scale 1-5), with mean ratings of 3.9 at 30 days and 4.2 at 90 days. PrEP uptake at 30 days was significantly higher in iRaPID (odds ratio: 5.40; 95% confidence interval, 1.37-21.26; p = .016) but not sustained at 90 days (odds ratio: 0.19; 95% confidence interval, 0.02-1.67; p = .133). Findings support the feasibility and acceptability of nurse practitioner-led, same-day PrEP delivery through a syringe services program while highlighting challenges to sustaining uptake.