# Integrated Rapid Access to HIV Prevention Program for People Who Inject Drugs (RAPID)

> **NIH NIH R21** · UNIVERSITY OF CONNECTICUT STORRS · 2020 · $212,567

## Abstract

Project Summary
 The HIV epidemic among people who inject drugs (PWID) has been on the decline, but amidst a burgeoning
opioid epidemic, communities are now increasingly vulnerable to HIV transmission. Recent HIV outbreaks
linked to drug injection has introduced HIV into PWID networks and thus, potentially reverse decades of HIV
prevention successes. While opioid agonist therapy (OAT) and syringe services programs (SSPs) reduce HIV
transmission, access to and utilization of such programs are unavailable or with limited availability; sexual and
injection-related HIV risks persist in many PWID. The integration of pre-exposure prophylaxis (PrEP) into
existing evidence-based programs (e.g., OAT, SSPs) has been presented as an opportunity to strengthen HIV
prevention efforts in PWID. Uptake, however, remains stubbornly low in PWID despite them being ideal
candidates and interested in starting PrEP. Data from our ongoing PrEP adherence trial in PWID show high rates
of attrition (43.7%) between the initial PrEP eligibility screening visit and PrEP initiation (usually 1-3 weeks).
Further, qualitative interviews indicate preferences for PrEP delivery that would decrease waiting times or
repeated visits altogether PrEP prescription. These early findings, supported by others, guide the need for rapid
PrEP initiation integrated within an existing harm reduction services that reduce or eliminates patient, clinician,
and structural barriers. Results from recent pilot studies have shown early acceptability, feasibility, and safety of
rapid (same-day) PrEP initiation in men who have sex with men (MSM) and transgender women (TGW), but
none of them include PWID, a group with extraordinary need in the current opioid crisis. Rapid PrEP initiation
may be particularly important for PWID as they are more likely to be lost before treatment initiation. To fully
optimize HIV prevention, PrEP care should be combined with OAT. Combining OAT with ART evolved from
physicians who would withhold antiretroviral therapy (ART) from PWID if they were using drugs; if patients
were OAT, ART prescription increased. Given the findings that advanced practice nurses (APNs) are more likely
to inquire in a patient-centered manner about their drug use and provide more supportive counseling, a new
differentiated care model of combined, same-day PrEP/OAT for PWID is well-suited to start with APNs. We,
therefore, propose to create a new HIV prevention model in PWID by: 1) Aim 1: Adapting PrEP delivery for
PWID by incorporating an APN-delivered, rapid HIV prevention program for PWID (iRaPID) that is delivered
by an APN and integrates same-day access to PrEP and OAT and 2) Aim 2: Using a Hybrid Type 1
implementation science design, we will compare PrEP and OAT uptake in a pilot randomized controlled trial
of the iRaPID vs. treatment as usual in HIV uninfected PWID with OUD. Together, these aims will address a
wide gap in HIV prevention by addressing multilevel barriers to dispensing same-day com...

## Key facts

- **NIH application ID:** 10363087
- **Project number:** 7R21DA051934-02
- **Recipient organization:** UNIVERSITY OF CONNECTICUT STORRS
- **Principal Investigator:** Roman Shrestha
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $212,567
- **Award type:** 7
- **Project period:** 2020-08-01 → 2022-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10363087

## Citation

> US National Institutes of Health, RePORTER application 10363087, Integrated Rapid Access to HIV Prevention Program for People Who Inject Drugs (RAPID) (7R21DA051934-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10363087. Licensed CC0.

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