This open-label randomised trial enrolled 409 HIV-negative adults with opioid use disorder who inject drugs, in five US cities. Both arms had 26 weeks of peer navigation; the intervention arm also had PrEP and buprenorphine on a mobile unit. At 26 weeks, biomarker-confirmed PrEP use was 5.4% vs 2.9%. Medication for opioid use disorder was 14.8% vs 10.7%; neither difference was significant. By 52 weeks, 4 intervention and 13 control participants had died (hazard ratio 0.29, 95% CI 0.1-0.9). The trial was not powered for mortality, and methadone was not available on the unit.
Why it is interesting: Uptake of PrEP and opioid medication stayed low in both arms, even with peer support. The lower death count was a secondary finding that the authors say bears replication.
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