Feasibility and acceptability of daily oral emtricitabine/tenofovir alafenamide fumarate (FTC/TAF) for HIV pre-exposure prophylaxis among people who inject drugs with opioid use disorder

To evaluate the feasibility and acceptability of daily oral emtricitabine/tenofovir alafenamide fumarate (FTC/TAF) as HIV pre-exposure prophylaxis (PrEP) among people who inject drugs with opioid use disorder (OUD). In this single-arm, open-label observational study, 100 people who inject drugs (PWID) were enrolled to receive daily oral FTC/TAF for HIV prevention through a community-based syringe services programme. Participants were referred for laboratory testing following enrolment and received a 90-day supply of FTC/TAF at baseline, 3-month and 6-month visits. Behavioural and biomedical data were collected at each follow-up visit. Feasibility was assessed by tracking the number of individuals screened, enrolled and retained in the study. Acceptability was measured at 3 and 6 months using an adapted 10-item acceptability rating profile. Adherence, uptake and side effects were assessed via self-report, and exit interviews were conducted at follow-up visits to provide qualitative context. Participants had a median age of 43.5 years (IQR: 38–53), 63% were male, 52% non-Hispanic white, 37% injected daily, 67% reported condomless sex and 21% reported prior PrEP use. Although all participants were prescribed FTC/TAF, only 60 collected PrEP at least once during the study; of these, 42 collected it only once, 16 two times and two at all three time points (baseline, 3-month and 6-month). Among those on PrEP, self-reported adherence increased from 68.14% (±34.76) over 3 months to 88.37% (±21.52) over 6 months. Acceptability was high (range: 1–4): 3 months (3.20 (±0.35)) and 6 months (3.10 (±0.17)). The most frequently reported side effects were fatigue (18.4%) and nausea (17.2%). There were no HIV seroconversions. FTC/TAF PrEP was acceptable among PWID with OUD. However, feasibility challenges were due to low uptake and continuation, with only two participants completing PrEP pick-up at all follow-up visits, despite higher self-reported adherence among those retained at 6 months.