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Background: The World Health Organization (WHO) recommends oral pre-exposure prophylaxis (PrEP) for all people at substantial risk of HIV as part of combination prevention. The extent to which this recommendation has been implemented globally for people who inject drugs is unclear. This study mapped global service delivery of PrEP for people who inject drugs
Methods: Between October and December 2021, information on PrEP services for people who inject drugs were sought from drug user-led networks and HIV, harm reduction, and human rights stakeholders. Websites of organisations involved in HIV prevention or services for people who inject drugs were searched. Models of service delivery were described in terms of service location, provider, and package.
Results: PrEP services were identified in 26 countries (17 high-income). PrEP delivery models varied within and across countries. In most services, PrEP services were implemented in healthcare clinics without direct links to other harm reduction services. In three countries, PrEP services were provided in clinics where drug treatment services were provided. In 14 countries, PrEP services were provided through community-based models that commonly involved peer-led outreach activities and integration with harm reduction services.
Conclusions: This study indicates limited PrEP availability for people who inject drugs. There is potential to expand PrEP services for people who inject drugs within harm reduction programmes, notably through community-based and peer-led services. PrEP should be offered as an additional HIV prevention choice for people who inject drugs and to strengthen a comprehensive harm reduction programme.