Preferences for PrEP Implementation and Engagement in the HIV Pre-Exposure Prophylaxis (PrEP) Care Continuum among Patients Receiving Psychiatric Care in an Ending the HIV Epidemic Priority County.

INTRODUCTION People living with mental illness (PLWMI) experience disproportionate HIV incidence. Research suggests use of HIV pre-exposure prophylaxis (PrEP) is low among PLWMI. The present study was conducted to understand self-reported HIV vulnerability, previous experiences with PrEP, interest in using PrEP, and preferences for PrEP modality and prescribers among PLWMI. METHODS We conducted a survey-based study among PLWMI seeking outpatient psychiatric care in Cook County, IL. The survey was completed online following a scheduled appointment with their psychiatric provider. Data was collected between February 2023-February 2024. Only HIV-negative PLWMI who met at least one PrEP eligibility criteria were eligible for the survey (eg. condomless sex, injection drug use, STI diagnosis). Outcomes were stratified by psychiatric diagnosis. RESULTS A total of 417 PLWMI completed the study (response rate = 66.7%) representing a diversity of diagnoses, including depression (43.4%), bipolar disorder (24.9%), and schizophrenia/schizoaffective disorder (6.7%). Awareness of PrEP was 74.8% and among those without prior PrEP use, 70.5% were interested. We found 27.6% of PLWMI had used PrEP previously. Long-acting injectable (LAI) was equally preferable (58.2%) to daily oral PrEP (58.8%) among PLWMI. Primary care providers (94.6%) were the most acceptable PrEP prescriber and 47.6% indicated acceptability of a psychiatrist as a PrEP prescriber. CONCLUSIONS PLWMI were interested in PrEP, including both oral and LAI formulations. Psychiatric care may serve as an efficient point of integration for PrEP prescription including LAI-PrEP. Further research is needed to understand how to best implement PrEP prescription and management for PLWMI across clinical settings.