Provider Perspectives on the Delivery of Long-Acting PrEP for HIV Prevention to Men Who Have Sex with Men and Who Use Methamphetamine

Methamphetamine use is associated with HIV risk behaviors, seroconversion, and suboptimal daily, oral PrEP adherence among men who have sex with men (MSM). Long-acting pre-exposure prophylaxis (PrEP) formulations, such as bimonthly cabotegravir (CAB) and biannual lenacapavir (LEN) injections, may be particularly effective for HIV prevention in this population. We conducted interviews with 17 individuals in the western US who provided a service in the past month to an HIV-negative man who has sex with men and uses methamphetamine. Interviews were audio recorded and transcribed. Interviews inquired about barriers to each step of the PrEP cascade and strategies to overcome them. Transcriptions were coded by at least two analysts and reconciled. Interviews revealed several barriers to long-acting PrEP engagement among MSM who use methamphetamine across the cascade, most notably homelessness, which included competing priorities and inconsistent phone access. Despite the identification of housing instability as a barrier to long-acting PrEP engagement, it was also cited as a reason why long-acting PrEP may be particularly promising for MSM who use methamphetamine. Anticipated stigma was also identified as a primary barrier to long-acting PrEP engagement. Provider-level barriers were described, including overburdened clinics, limited hours, requisite staffing expertise, and billing restrictions. Strategies to increase long-acting PrEP provision among this population who could benefit from PrEP included reducing provider-side barriers and integrating long-acting PrEP with other appealing services (e.g., syringe services programs), extended hours, mobile delivery, and contingency management.