# Integrated PrEP Interventions for People Who Inject Drugs in Rural Kentucky

> **NIH NIH R34** · UNIVERSITY OF KENTUCKY · 2021 · $194,922

## Abstract

ABSTRACT
Rural areas in the United States are increasingly impacted by HIV, tied to the ongoing opioid epidemic,
growing stimulant use, and widespread drug injection. Kentucky (KY) is among seven states identified with
heavy rural HIV burden and increasing rates of new HIV diagnoses attributable to injection drug use. Rural
HIV outbreaks among people who inject drugs (PWID) have occurred recently in KY’s neighboring states,
highlighting the urgent need to implement proven HIV prevention and harm reduction strategies for PWID in
KY’s rural areas. A key pillar of Ending the HIV Epidemic (EHE): A Plan for America is the prevention of new
HIV infections through scale up of evidence-based interventions, including syringe service programs (SSPs)
and Pre-exposure prophylaxis (PrEP). Our R21 in KY’s Appalachian region demonstrated consistent utilization
of rurally located SSPs by high-risk PWID, making SSPs a critical venue to scale delivery of comprehensive
HIV prevention services in rural areas. In a prior RCT conducted by the PI of this application, strengths-based
case management (SBCM) interventions were shown to be effective in increasing HIV testing and overcoming
barriers to medical care among people who use drugs. Building on this prior work and ongoing collaboration
with rural SSPs in KY, this R34 will adapt and integrate a novel PrEP initiation intervention at point of
care in rural SSPs, in two KY counties that are among the nation’s top 10 most vulnerable to HIV
among PWID, and conduct a preliminary test of its efficacy. The Specific Aims are to: 1) Assess client,
provider, organization, and structural-level facilitators and barriers to integration of a PrEP focused
SBCM (SBCM-PrEP) intervention into routine SSP practice. Guided by the PRISM model, we will conduct
semi-structured key informant interviews with PWID, clinical care and harm reduction service providers, and
facility administrators in our targeted SSP implementation locations, to identify individual, organizational, and
structural challenges and opportunities to adapt the SBCM-PrEP to enhance client acceptability, accessibility
and compatibility with clinical workflow; 2) Adapt an evidence-based SBCM protocol to provide PrEP
intervention services for PWID in SSP sites. Using in-depth interview data from Aim 1, we will adapt, refine
and incorporate HIV prevention content most salient to PrEP care into the SBCM-PrEP, following the ADAPT
ITT framework; and 3) Examine feasibility, acceptability and preliminary efficacy of the adapted SBCM-
PrEP. 80 participants will be randomized into: CDC-PrEP (an in-use PrEP intervention based on CDC
guidelines), or SBCM-PrEP. Primary outcomes include feasibility and acceptability (measured by intervention
attendance, engagement, and satisfaction) during the active intervention period, and preliminary efficacy on
PrEP initiation (measured by dispensed PrEP prescription) 3- and 6- months post-baseline. The proposed
study fills a gap in evidence for ...

## Key facts

- **NIH application ID:** 10320665
- **Project number:** 1R34DA053140-01A1
- **Recipient organization:** UNIVERSITY OF KENTUCKY
- **Principal Investigator:** HILARY L SURRATT
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $194,922
- **Award type:** 1
- **Project period:** 2021-08-01 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10320665

## Citation

> US National Institutes of Health, RePORTER application 10320665, Integrated PrEP Interventions for People Who Inject Drugs in Rural Kentucky (1R34DA053140-01A1). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10320665. Licensed CC0.

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