Preferences for PrEP Implementation and Engagement in the HIV Pre-Exposure Prophylaxis (PrEP) Care Continuum among Patients Receiving Psychiatric Care in an Ending the HIV Epidemic Priority County.

Abstract

Introduction: People living with mental illness (PLWMI) experience disproportionate HIV incidence. Research suggests use of HIV pre-exposure prophylaxis (PrEP) is low among PLWMI. The present study was conducted to understand self-reported HIV vulnerability, previous experiences with PrEP, interest in using PrEP, and preferences for PrEP modality and prescribers among PLWMI.

Methods: We conducted a survey-based study among PLWMI seeking outpatient psychiatric care in Cook County, IL. The survey was completed online following a scheduled appointment with their psychiatric provider. Data was collected between February 2023-February 2024. Only HIV-negative PLWMI who met at least one PrEP eligibility criteria were eligible for the survey (eg. condomless sex, injection drug use, STI diagnosis). Outcomes were stratified by psychiatric diagnosis.

Results: A total of 417 PLWMI completed the study (response rate = 66.7%) representing a diversity of diagnoses, including depression (43.4%), bipolar disorder (24.9%), and schizophrenia/schizoaffective disorder (6.7%). Awareness of PrEP was 74.8% and among those without prior PrEP use, 70.5% were interested. We found 27.6% of PLWMI had used PrEP previously. Long-acting injectable (LAI) was equally preferable (58.2%) to daily oral PrEP (58.8%) among PLWMI. Primary care providers (94.6%) were the most acceptable PrEP prescriber and 47.6% indicated acceptability of a psychiatrist as a PrEP prescriber.

Conclusions: PLWMI were interested in PrEP, including both oral and LAI formulations. Psychiatric care may serve as an efficient point of integration for PrEP prescription including LAI-PrEP. Further research is needed to understand how to best implement PrEP prescription and management for PLWMI across clinical settings.