LAI-PrEP willingness among people who inject drugs in Appalachian Ohio: applying the Information-Motivation-Behavioral Skills Model

HIV remains a critical public health challenge in rural areas of the United States. Yet pre-exposure prophylaxis for HIV (PrEP) access is limited. Long-acting injectable PrEP (LAI-PrEP) could overcome barriers among people who inject drugs (PWID), but PWID’s willingness to engage with LAI-PrEP is uncertain. To deepen our understanding of determinants influencing LAI-PrEP uptake, the Information-Motivation-Behavioral Skills (IMB) model can serve as a guiding framework. Using data from the Measuring Resilience study, a cross-sectional survey among n = 250 PWID in Appalachian Ohio, we mapped survey items onto the IMB model. Then, we fit a structural equation model within a Bayesian estimation framework. Only 1 in 3 PWID were willing to receive LAI-PrEP. For information, awareness of HIV prevention (loading = 1 [fixed]) and HIV transmission (loading = 1.11 [95% credible interval, CI 0.41, 2.46]) were important. For motivation, important items were perceived risk of HIV and PrEP- and HIV-related stigma (loadings ranged from 0.82 [95% CI 0.15, 1.69] to 3.89 [95% CI 2.23, 6.20]). Important behavioral skills were confidence in attending regular appointments (loading = 1 [fixed]) and managing side effects (loading = 0.96 [95% CI 0.72, 1.28]). Behavioral skills had the strongest association with LAI-PrEP willingness (β = 3.71 [95% CI 2.21, 5.86]). Motivation also had a credible, positive effect (β = 1.68 [95% CI 0.02 ,3.69]). But, information was not associated with LAI-PrEP willingness (β = 0.22 [95% CI -0.87, 1.41]). Our findings demonstrate that the IMB model is useful for understanding LAI-PrEP willingness among rural PWID. The IMB model can identify modifiable factors for future, locally tailored implementation programs to address.