Testing the feasibility, acceptability, and preliminary efficacy of integrating accommodation strategies into an HIV prevention intervention for people who inject drugs with cognitive dysfunction

Background: Cognitive profiles of individuals with opioid use disorder (OUD) limit patients' ability to learn, retain, and recall HIV prevention information. It also limits adherence to medications, such as pre-exposure prophylaxis (PrEP). Cognitive dysfunction accommodation strategies have shown promise at reducing HIV-related risk behaviors among individuals with OUD and increasing adherence to PrEP. This study investigated the feasibility, acceptability, and preliminary efficacy of integrating accommodation strategies into a behavioral HIV prevention intervention.

Methods: This 2-arm single blind study provided 50 people who inject drugs (PWID) with OUD linkage to PrEP services and randomized them to a 4-week HIV prevention intervention condition. The active control condition received the HIV prevention intervention as treatment per usual, while the experimental condition received the enhanced HIV prevention intervention with added accommodation strategies. Participants completed acceptability ratings of intervention content and accommodation strategies post-intervention; feasibility was measured via participant recruitment and retention. HIV risk reduction information, motivation, and behavior (IMB) assessments and HIV risk reduction skills assessments were completed pre/post-intervention. Participants also completed weekly PrEP adherence assessments.

Results: The intervention content received a high acceptability rating (89 %). Intervention feasibility was deemed acceptable, with 80 % of participants completing all study protocols. The accommodation strategies integrated into the HIV prevention sessions were also endorsed by 92 % of participants. Participants in the experimental condition had significant increases in retention and recall of how to perform HIV risk reduction skills including how to properly clean a syringe (p = 0.048) and how to accurately apply a female condom (p = 0.025), compared to the control condition. Weekly PrEP adherence was reported by the three (7.5 %) participants who indicated taking PrEP throughout the study. All three participants reported missing doses throughout each of the 4 weeks.

Conclusions: Results from this study highlight the potential for integrating accommodation strategies into behavioral HIV prevention interventions to reduce the risk of HIV among PWID. Future research is needed to evaluate the use of such strategies by larger and diverse samples of PWID, as well as whether accommodation strategies enable the retention and recall of HIV prevention information and HIV prevention skills over longer periods of time.

Trial registration: This trial has been retrospectively registered at ClinicalTrials.gov on June 12, 2023. (NCT05912374).