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Optimizing Low Threshold TelePrEP Care for People who Inject Drugs in Appalachia

Award Number: R34DA060087
ORGANIZATION: NATIONAL INSTITUTE ON DRUG ABUSE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 05/01/2024
PERIOD OF PERFORMANCE END DATE: 04/30/2027

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Optimizing Low Threshold TelePrEP Care for People who Inject Drugs in Appalachia - ABSTRACT Kentucky (KY) is a high priority Ending the HIV Epidemic (EHE) jurisdiction due to heavy rural HIV burden and exceptionally high rates of new HIV diagnoses driven by injection drug use (IDU): 32% of newly HIV-diagnosed women in KY have IDU as a transmission factor, as do 15% of men, compared to 16% and 5%, respectively, across the US. Despite ongoing need for robust HIV prevention and the strong evidence for Pre-Exposure Prophylaxis (PrEP), uptake remains severely limited among people who inject drugs (PWID). PWID in rural areas are impacted by resource challenges that impede entry and retention in PrEP care, , including limited healthcare access and a dearth of PrEP providers . An interim assessment of EHE progress notes that PrEP coverage remains well below threshold to reach established EHE targets, and sets out broad policy recommendations to enhance PrEP access by engaging people where they are. For PWID in particular, there is broad scientific consensus that PrEP efforts be intensified and intentional in supporting low threshold PrEP access. The proposed study will develop, integrate and test a low threshold peer-facilitated TelePrEP intervention for Appalachian PWID within local health department-based clinic programs that operate within “PrEP deserts,” a term for communities that lack sufficient numbers of PrEP providers. The PI’s ongoing research and existing partnerships with local health departments in Appalachian KY have demonstrated that PWID have low PrEP awareness and knowledge, yet interest in PrEP is high, at 73%. Preliminary data indicate high acceptability to participate in tailored PrEP education and point of care PrEP testing within Appalachian health department-based clinics. Building on this existing work and strong partnerships with local health departments, we will conduct a pilot randomized trial to examine efficacy on PrEP initiation (measured by dispensed PrEP prescription) and retention in PrEP care 3- and 6- months post-baseline (measured by selfreport and biomarker confirmation) as well as implementation outcomes guided by the Implementation Outcomes Framework. The Specific Aims are to: 1) Collaborate with the Clark County Health Department (CCHD) and Kentucky River District Health Department (KRDHD) to develop the optimal content, delivery structure, and implementation strategies for the peer-facilitated TelePrEP intervention and rapidly manualize the novel low threshold protocol; 2) Conduct a pilot randomized trial to evaluate the preliminary efficacy of: a) peer-facilitated, integrated TelePrEP; compared with b) peerdelivered PrEP education and referral, on PrEP initiation and persistence among Appalachian PWID; and, 3) Examine feasibility, acceptability, appropriateness, and fidelity implementation outcomes of the two intervention comparators among PWID participants and program staff using a mixed methods approach. The proposed study will establish preliminary evidence and proof-of-concept for an integrated low-threshold TelePrEP intervention for Appalachian PWID, which is designed to extend PrEP access in rural communities. Innovative interventions to increase PrEP initiation and persistence by PWID fill a critical need for studies to improve the PrEP care cascade among PWID.


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 = $179,085 )
2026	2026	UNIVERSITY OF KENTUCKY RESEARCH FOUNDATION, THE	500 S LIMESTONE	LEXINGTON	KY	40526	FAYETTE	USA	Drug Use and Addiction Research Programs	000	3	5/11/2026	NON-COMPETING CONTINUATION	$179,085
														Subtotal = $179,085

Issue Date FY: 2025 ( Subtotal = $296,530 )
2025	2025	UNIVERSITY OF KENTUCKY RESEARCH FOUNDATION, THE	500 S LIMESTONE	LEXINGTON	KY	40526	FAYETTE	USA	Drug Use and Addiction Research Programs	000	2	4/22/2025	NON-COMPETING CONTINUATION	$296,530
														Subtotal = $296,530

Issue Date FY: 2024 ( Subtotal = $194,380 )
2024	2024	UNIVERSITY OF KENTUCKY RESEARCH FOUNDATION, THE	500 S LIMESTONE	LEXINGTON	KY	40526	FAYETTE	USA	Drug Use and Addiction Research Programs	000	1	4/22/2024	NEW	$194,380
														Subtotal = $194,380

Grand Total All Awards = $669,995

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Optimizing Low Threshold TelePrEP Care for People who Inject Drugs in Appalachia

Award Number: R34DA060087

ORGANIZATION: NATIONAL INSTITUTE ON DRUG ABUSE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

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

PERIOD OF PERFORMANCE START DATE: 05/01/2024

PERIOD OF PERFORMANCE END DATE: 04/30/2027

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