ABSTRACT
Background. The CDC recommends that PrEP be offered to anyone with a history of injection drug use, with a particular focus on those that have injected in the past 6 months, shared injection equipment, or have sexual risk factors. Yet, PrEP remains underutilized. The SARS-CoV2 pandemic introduced additional barriers to HIV testing and substance use treatment. We sought to develop a specialty pharmacydriven program to minimize barriers and increase education surrounding PrEP in PWID in patients admitted to the hospital with IV drug use related complications. Patients identified by the ID consultant or stewardship team were offered enrollment in the program as part of a comprehensive harm reduction strategy. Upon referral, specialty pharmacists provided phone counseling, prescribed TDF/FTC, and conducted laboratory monitoring. Methods. From November 2020 through March 2022, we collected data on our accepted referrals including number of refills, laboratory appointments, reason for discharge, duration of retention in the program, and injection-related emergency department visits and hospital admissions for 90 days after program discharge. Results. During the eighteen month period, 23 patients accepted referral into the program. The median age was 42 years and 47.8% were male. Despite accepting the initial referral while inpatient, 87% (n=20) of patients did not remain in the program to receive the first month's supply of TDF/FTC once discharged. Sixteen (69.6%) were not able to be contacted on the phone number provided despite multiple attempts. Four (17.4%) declined ongoing IV drug use. Eight patients (35%) had an injection related ED visit or hospitalization within 90 days of program discharge. Conclusion. In conclusion, high risk PWID admitted to the hospital who agreed to PrEP with daily TDF/FTC had a low retention rate after discharge. PWID need to be included in future research studies, especially studies involving novel PrEP treatments.