(PL40) "I'M A REALLY HARD STICK": BARRIERS, FACILITATORS, AND PREFERENCES IN EMERGENCY DEPARTMENT HIV TESTING AMONG PEOPLE WHO INJECT DRUGS

Background:
Suffolk County, Massachusetts is an Ending the HIV Epidemic (EHE) priority area with an ongoing cluster of HIV transmission among people who inject drugs (PWID). Many PWID with HIV in this cluster had accessed care in emergency departments (EDs) prior to diagnosis but were not offered HIV testing there. ED-based HIV testing and PrEP initiation have thus become local EHE priorities.

Methods:
We conducted in-depth interviews with 26 PWID recruited from a low-threshold clinic for substance use disorder treatment in Boston, Suffolk County, Massachusetts serving people who were recently in the ED. Interviews were recorded and transcribed. We identified themes related to acceptability, barriers, and facilitators to HIV testing and PrEP initiation in the ED for PWID.

Results:
Mean participant age was 37 years (SD 11.8); 69.2% identified as white and 26.9% as Latinx; 65.3% lived at or below the federal poverty level. Findings were organized around five themes: 1) Need for multimodal HIV testing, 2) Distrust begets distrust, 3) Context-dependent interest in HIV testing, 4) Creating safe and supportive settings, and 5) PrEP misconceptions. Participants were supportive of HIV testing in the ED but expressed a range of preferences for testing modality (e.g., saliva, venipuncture, finger prick). Distrust of PWID by ED providers were frequently described, resulting in reciprocal distrust of providers. Willingness to accept HIV testing was often associated with recent potential HIV exposures such as needle sharing. Participants desired provider-driven efforts to discuss HIV testing and PrEP in safe and supportive environments. Many participants held the misconception that injection drug use is not an appropriate reason to use PrEP.

Conclusion:
PWID are supportive of HIV testing and PrEP initiation in EDs, but efforts may be further optimized. Possible modifications include offering multiple HIV testing modalities and creating safe, confidential spaces to discuss testing and PrEP.