Stakeholder Perspectives on Long-Acting Injectable PrEP and MOUD: A Descriptive Qualitative Study

Long-acting injectable (LAI) formulations of pre-exposure prophylaxis (PrEP) and medications for opioid use disorder (MOUD) offer promising new approaches for addressing the intersecting challenges of HIV and opioid use disorder (OUD) in carceral settings. However, successful implementation requires understanding the perspectives of key carceral and community stakeholders. This qualitative study involved 17 semi-structured stakeholder interviews including correctional staff (medical and administrative) and community healthcare providers. Participants were recruited from jails in Washington, DC and surrounding Maryland counties. Interviews were coded using a mixed inductive and deductive methodology, and data were analyzed to identify key themes. Four overarching themes relevant to implementation emerged: (1) The presence of resource barriers, including jail staffing shortages and financial constraints; (2) Challenges administering medications including stigma, medical mistrust, and limited patient knowledge of medications; (3) challenging and restrictive carceral infrastructure; and (4) the importance of care continuity during carceral-to-community transition. Stakeholders emphasized that while LAI PrEP and MOUD could provide critical support to justice-involved individuals, systemic barriers challenged successful implementation and delivery in jail and during community re-entry. Our findings underscore the need for targeted interventions to address the resource, medication, and infrastructure challenges identified. Ensuring sustainable funding, providing staff training and education, improving patient education, addressing stigma, and strengthening community linkages are essential for the successful implementation of LAI PrEP and MOUD in carceral settings. These insights can inform future policies and practices aimed at improving health outcomes for justice-involved populations.