Community Insights on the Acceptability of Location-enabled Devices to Improve Retention in Care and Prevention Among People Who Inject Drugs, Oakland and San Francisco, California

BACKGROUND: People who inject drugs (PWID), who are disproportionately affected by HIV and HCV, also face structural barriers to antiretroviral therapy (ART), pre-exposure prophylaxis (PrEP), and HCV treatment and prevention retention. Global positioning system (GPS) devices may help locate them and support their navigation through healthcare and social services. METHODS: We conducted a mixed-methods study to assess the acceptability of carrying GPS devices among participants of a community-recruited cohort of PWID in Oakland and San Francisco, California. RESULTS: A majority (61%) were willing to carry GPS devices; an additional 14% were open to it with more information; 4% were uncomfortable; 13% were not willing; and 8% were unsure. Interest was high among unhoused PWID, those affected by street sweeps, those interested in long-acting injectable PrEP, and those with a history of HCV infection. Black/African American PWID expressed lower interest compared to other racial/ethnic groups. Common concerns included fear of being located while using or acquiring substances, potential access to locating data by law enforcement, fear of device theft or loss, and increased paranoia. CONCLUSIONS: The high willingness to carry GPS devices suggests these tools could support sustained engagement in research, healthcare, and social services. Effective implementation will require introducing these technologies in ways that are transparent and responsive to PWID's priorities and lived experiences. These GPS-based retention strategies may have broad implications for a wide range of health issues faced by PWID populations.