Preventing HIV infection among people who inject drugs during COVID-19

This application is being submitted in response to NOT-DA-20-047. Injection drug use has contributed to newHIV outbreaks in many regions of the United States. The parent K01 award seeks to improve the delivery ofantiretroviral pre-exposure prophylaxis (PrEP) to people who inject drugs (PWID) through syringe serviceprograms (SSPs), which provide essential HIV prevention services to this population. Large-scale public healthemergencies, as well as the measures undertaken to mitigate them, can increase HIV risk among PWID (e.g.,by impacting drug market characteristics and drug-related and sexual risk behaviors) while also impacting thedelivery of essential prevention services. This administrative supplement proposes longitudinal, mixed methodsdata collection to understand the impacts of the 2019 Novel Coronavirus (2019-nCoV or COVID-19) on HIV-related risk among PWID and SSPs' capabilities to provide PrEP and other HIV prevention services over thecourse of the pandemic. Due to restrictions on in-person research encounters in the context of infectiousdisease transmission, over the course of six months, we propose virtual (video-conference) qualitativeinterviews with 40 PWID and 20 SSP staff as well as modified, weekly quantitative ecological momentaryassessment (EMA) with participating SSPs to understand evolutions in PWID risk behaviors (Aim 1), SSPorganizational functioning and staff wellbeing (Aim 2), and EMA feasibility and SSP service provision in thecontext of a large-scale emergency (Aim 3). Guided by the socio-ecological model, our mixed methodsanalyses will provide critical evidence on how to sustain the delivery of PrEP and other essential HIVprevention services to at-risk PWID during large-scale public health emergencies. Our primary innovations arethe longitudinal examination of individual and organizational responses to the COVID-19 pandemic over time,the use of virtual data collection methods (including EMA with SSPs) that leverage the parent K01 award'snetwork of community research collaborations, and the mixed methods approach to eliciting multiplestakeholder perspectives on the impacts of this unprecedented pandemic on HIV prevention with a vulnerablesubstance-using population. Findings from this supplement will inform efforts to promote sustained HIVprevention service delivery during future public health emergencies while also enhancing the success of theparent K01 award focused on SSP-based implementation of PrEP for HIV prevention in a highly sociallymarginalized population.