Staff Perspectives on Implementation of Long-Acting Injectable Preexposure Prophylaxis at a Low-Barrier Syringe Services Program in Philadelphia, PA.

Abstract

IntroductionLong-acting injectable cabotegravir (CAB-LA) for preexposure prophylaxis (PrEP) is a promising HIV prevention tool for people who inject drugs (PWID), who face elevated HIV risk and barriers to care. While acceptable to PWID, CAB-LA implementation in low-barrier syringe services programs (SSPs) has not been examined.MethodsFrom August 2023 to July 2025, we conducted semistructured interviews with 12 SSP staff involved in CAB-LA delivery. Interviews were transcribed and analyzed using thematic analysis guided by the Consolidated Framework for Implementation Research.ResultsFacilitators included CAB-LA's relative advantage over oral PrEP, external technical support, 340B pharmacy revenue, alignment with SSP mission and workflows, motivated staff, and financial incentives. Barriers included lack of FDA approval for PWID, complex logistics, performance pressures, infrastructure constraints, competing priorities, staff workload, and client outreach and engagement.ConclusionIntegrating CAB-LA into SSPs is promising, but successful implementation requires targeted strategies, including additional resources, workflow adaptations, and enhanced outreach.