# Prison PrEP Values Adherence and Implementation in Lusaka (PrEVAIL)

> **NIH NIH R21** · UNIVERSITY OF MARYLAND BALTIMORE · 2024 · $156,118

## Abstract

PROJECT SUMMARY
Incarcerated people are one of the key populations at the center of the HIV epidemic in Zambia and sub-Saharan
Africa (SSA) in general. The periods during and after incarceration likely represent times of significant HIV risk,
yet little is known about HIV infection vulnerability during these times or how best to provide incarcerated people
with HIV prevention services such as pre-exposure prophylaxis (PrEP) to reduce HIV risk. To address these
knowledge gaps, we propose the Prison PrEP Values, Adherence, and Implementation in Lusaka (PreVAIL)
study. Our scientific premise is that providing effective combination prevention to incarcerated and justice-
involved populations requires understanding both temporal changes in their HIV risk and patterns of their PrEP
uptake, adherence, and persistence. The long-term goal of this work is to optimize the timing and delivery of
PrEP, as part of combination prevention, for justice-involved persons in Zambia. The objective of this R21 is to
characterize PrEP uptake, adherence, and persistence, as well as HIV risk perceptions and behaviors, among
justice-involved persons during incarceration and transition to the community.
PreVAIL builds on a robust platform for corrections-health research and service delivery in Zambia. The TasP
study (Co-PI: Herce) was the first to assess universal test and treat for HIV for incarcerated people in SSA, the
NIH-funded CONTINUUM study (PI: Herce) was one of the first studies to follow incarcerated people after
release in SSA, and the CDC/PEPFAR-funded CIRKUITS project (PI: Claassen, Co-PI: Herce) is conducting
one of the first demonstrations of PrEP for justice-involved people in SSA.
In Aim 1 we will assess PrEP uptake, adherence, and persistence, as well as HIV risk factors and
perception of HIV risk, among justice-involved people during incarceration and post-release. We will
prospectively enroll a cohort of 800 HIV-negative and PrEP-eligible incarcerated people at prison entry and offer
them oral PrEP. We will follow all cohort members for 12 months regardless of PrEP status, both during
incarceration and following release. Primary outcomes include PrEP uptake, adherence, and persistence, as
well as HIV status, HIV risk behaviors and risk perception. PrEP adherence will be assessed through self-report
and a novel point-of-care urine tenofovir test.
In Aim 2, we will use qualitative research methods to explore and understand barriers and facilitators of
PrEP uptake, adherence, and persistence during incarceration and after release. We will purposively
sample 40 participants from our cohort for theory-informed longitudinal in-depth interviews to understand multi-
level barriers and facilitators to efficacious PrEP use, as well as PrEP method and service delivery preferences.
This study will provide new insights into HIV risk for justice-involved people in Africa and quantify the magnitude
of the gap in HIV prevention service continuity, leading to a future,...

## Key facts

- **NIH application ID:** 10819509
- **Project number:** 5R21MH129162-02
- **Recipient organization:** UNIVERSITY OF MARYLAND BALTIMORE
- **Principal Investigator:** Cassidy W. Claassen
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $156,118
- **Award type:** 5
- **Project period:** 2023-04-04 → 2026-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10819509

## Citation

> US National Institutes of Health, RePORTER application 10819509, Prison PrEP Values Adherence and Implementation in Lusaka (PrEVAIL) (5R21MH129162-02). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10819509. Licensed CC0.

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