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Street PrEP: Expanding a Low-Barrier PrEP Delivery Model Among People Who Use Drugs and Experiencing Homelessness in San Francisco

Award Number: R01DA065104
ORGANIZATION: NATIONAL INSTITUTE ON DRUG ABUSE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 04/15/2026
PERIOD OF PERFORMANCE END DATE: 01/31/2031

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Street PrEP: Expanding a Low-Barrier PrEP Delivery Model Among People Who Use Drugs and Experiencing Homelessness in San Francisco - Abstract HIV disproportionately impacts people who use drugs while scale up of prevention interventions lag for this population. New HIV diagnoses in San Francisco among people who inject drugs increased by 34% from 2019 to 2021. Rises in methamphetamine and fentanyl both by injection and non-injection use are associated with new HIV infections. While efforts to address substance use have grown, little has been done to address HIV among people who use drugs. A 2022 survey of people who inject drugs in San Francisco found that HIV testing went down 30% from the prior 2 years and only 1.2% of participants had used HIV pre-exposure prophylaxis, or PrEP, in the past year. People who use drugs face unique structural and substance use-related challenges to accessing services, amplifying their vulnerability for HIV and reducing their uptake of PrEP. In the face of increasing HIV transmission, evidence-based interventions demonstrating successful PrEP uptake and persistence remain limited, representing a widening gap in public health. Our team proposes to test the Street PrEP intervention, which brings the state of the science in HIV prevention directly to people who use drugs in San Francisco. People who use drugs and are at the highest risk of HIV will be reached via respondent-driven sampling (N=150), leveraging an existing cohort study and connections to social networks of people who use drugs in San Francisco (aim 1). Participants will then be randomized to standard of care clinic linkages or the Street PrEP intervention, which includes access to a mobile health clinic, tailored navigation to address HIV prevention and substance use needs, and transportation to low-barrier drop-in clinics for ongoing healthcare (aim 2). Using a type 2 hybrid effectiveness-implementation randomized trial, we will measure the impact of the Street PrEP intervention on PrEP uptake and persistence among people who use drugs in San Francisco. In aim 3, we will assess barriers and facilitators to implementation and evaluate implementation outcomes throughout the course of the study via qualitative interviews with people who use drugs (n=12-15) and staff (n=5-7). We have assembled a highly experienced, multidisciplinary team of investigators, comprised of leading PrEP, substance use, HIV, and implementation science researchers, addiction medicine and HIV providers, and an experienced biostatistician. If we find the intervention to be effective, we will develop an implementation toolkit to facilitate dissemination of the Street PrEP intervention to other jurisdictions that can use this model to improve PrEP uptake and persistence among people at risk of HIV who use drugs.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $588,669 )
2026	2026	PUBLIC HEALTH FOUNDATION ENTERPRISES, INC.	13300 CROSSROADS PKWY N	CITY OF INDUSTRY	CA	91746	LOS ANGELES	USA	Drug Use and Addiction Research Programs	000	1	4/13/2026	NEW	$588,669
														Subtotal = $588,669

Grand Total All Awards = $588,669

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Street PrEP: Expanding a Low-Barrier PrEP Delivery Model Among People Who Use Drugs and Experiencing Homelessness in San Francisco

Award Number: R01DA065104

ORGANIZATION: NATIONAL INSTITUTE ON DRUG ABUSE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 04/15/2026

PERIOD OF PERFORMANCE END DATE: 01/31/2031

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