Table 1.

Summary of included studies for drug-using women (n=7 studies)

Authors	Location and time	Recruitment	Characteristics of participants	Study design	Key measurements	Key findings	10GRADE rating	Notes
Levin2014; Kuo 2016	Washington, DC (2012)	IDUs were recruited using3RDS from4NHBS 2012 system and completed a detailed behavioral quantitative interview and underwent rapid testing for HIV	HIV-negative IDUs, N=304 (203 males, 98 females), and 82.7% were 50 yrs or older, Black=97.2%	cross sectional; quantitative	Willingness of PrEP use (e.g., “If a daily HIV pill to prevent you from getting HIV was available in DC for free or was covered by your health insurance, how likely would you be to take it?”)	Only 13.4% had ever heard of using anti-HIV medication to prevent HIV; none had ever used PrEP or knew anyone who used it in the past year. Fortyseven percent were very likely and 24% were somewhat likely to take PrEP if it were available without cost; 13% agreed they would not need to sterilize/clean needles or use condoms if taking PrEP. None had ever taken PrEP.	⊕⊕OO Observational study design with limited representativeness; risk of bias is low or unclear	Mixed men and women; IDU only; no racial specific analyses; hypothetical scenario; self-reported HIV negative
Metz 2017	NYC (2014–2015)	Participants had responded to local flyer or newspaper advertisements for nontreatment-seeking adults with opioid use disorders who would like to participate in a clinical research study. The current study was conducted at the substance use research center.	138 adults with Opioid Use Disorder (24 female, 114 male); mean age=46.5 years (7SD = 9.5); Black=46.3%, White=24.6%, Hispanic=24.6%	cross sectional; quantitative	PrEP Awareness : Participants were asked about chemical prevention, Truvada, and PrEP	29% of all participants heard of Truvada, and 30% heard of PrEP. White opioid users showed the most risk behaviors among races/ethnicities, despite comparable prevention knowledge. 3 HIV positive among women (3/24=13%), 30% women are IDU.	⊕OOO Observational study design with a very small sample size; risk of bias is low or unclear	Mixed men and women; Mixed types of drug users, no gender specific data available; hypothetical scenario; urine toxicology for drug dependency, self-reported HIV status
Peitzmeier 2017	Baltimore, MD (2015)	Participants were recruited from two sites of a mobile health service that provides needle exchange and sexual/reprod uctive health services in Baltimore, Maryland	Female sex workers, N=60, mean age= 35.5yrs, Black=16%,White=72%, IDU=90%	cross sectional; quantitative	1PrEP awareness (e.g., “HIV Pre-exposure prophylax is, or PrEP, is a way for people who do not have HIV to prevent HIV infection by taking a pill every day. Have you heard of HIV PrEP before today”); Willingness of PrEP use (e.g., “How interested would you be in taking a pill every day to prevent HIV infection”)	33% heard of PrEP; 65% were interested in taking PrEP; Self-efficacy for daily oral adherence (79%); 78% were still interested in using PrEP even if condoms were still necessary; potential risk compensation (22%)	⊕OOO Observational study design with a small sample size; risk of bias is low or unclear	Women only;90%2IDU; no racial-specific analyses; hypothetical scenario; no assessment of HIV status
Shrestha 2016, 2017	Connecticut (2016)	A convenience sample of 400 participants was recruited at Connecticut’s largest6MMP;8ACASI-based survey.	400 HIV-negative, opioid dependent participants (234 males and 166 females); mean age=40.9yrs (SD=11.1); non-White=36.8%, White=63.2%	cross sectional; quantitative	PrEP Awareness (yes vs. no); Willingness of PrEP use (e.g., “I would be interested in taking PrEP to reduce my current risk of HIV infection” on a five-point Likert scale.)	While only 72 (18%) were aware of PrEP, after being given a description of it, 251 (62.7%) were willing to initiate PrEP. Among those willing to initiate PrEP, only 12.5% and 28.2%, respectively, indicated that they would always use condoms and not share injection equipment while on PrEP. 1.8% of participants ever used PrEP.	⊕⊕OO Observational study design with indirect measurement of willingness; risk of bias is low or unclear	Mixed men and women; Mixed types of drug users, hypothetical scenario;, selfreported HIV negative
Stein 2014	Massachusetts (2013)	Consecutive persons seeking opioid detoxification were approached at the time of admission to Stanley Street Treatment Addiction and Recovery in Fall River, Massachusetts to participate in a survey research study.	351 opiate injectors entering detoxification treatment (105 female opiate injectors, 246 males), 87% non-Hispanic White; mean age=32.2yrs (SD=10.1)	cross sectional; quantitative	PrEP Awareness (e.g., “Have you heard of a pill that is safe and effective in lowering transmission of HIV?”); Willingness of PrEP use (e.g., “Would you be willing to take a once a day pill every day to lower your risk 90% (or 40%) of becoming HIV positive?”)	Only 7.4% had heard of a drug to reduce HIV risk, yet once informed, 47.1% would be willing to take such a pill [35% of those in the low effectiveness scenario and 58% in the high group (p < .001)]; perceived no risk of HIV (45.1%) and perceive barriers of PrEP use	⊕⊕OO Observational study design with inconsistent measurement of willingness; risk of bias is low or unclear	Mixed men and women; IDUs only, no race specific analyses; hypothetical scenario. Toxicologi cally confirmed; self-reported HIV status
Walter 2017-NYC	NYC (2011–2013)	NHBS2012 system was conducted in 20 cities. Data for this analysis was from the5NYC, and RDS was used; face-to-face interviews	122 female IDUs: 29% were 50 yrs or older; Black=25%, Hispanic=52%, White=22%	cross sectional; quantitative	PrEP Awareness (e.g., “Before today, have you ever heard of people who do not have HIV taking antiretroviral medicines, to keep from getting HIV?”	Female IDU had 52% of decreased odds of PrEP awareness compared to MSM. Only 12% female IDU reported PrEP awareness; 14% (n=17) were HIV positive	⊕⊕OO Observational study design with limited representativ eness; risk of bias is low or unclear	IDU only; no racial-specific analyses; hypothetical scenario; women-specific data available; selfreported HIV status
Walter 2017-Long Island	Long Island (2011–2013)	Data for this analysis was from the Nassau-Suffolk, NY (ie, Long Island), part of the NHBS using RDS; face-to-face interviews	63 female IDUs: 25% were 50 yrs or older; Black=56%,Hispanic=8%, White=37%			Female IDU had 82% of decreased odds of PrEP awareness compared to MSM. Only 8% female IDU reported PrEP awareness; 6% (n=4) were HIV positive
Walters 2017	NYC (2015)	2015 National HIV Behavioral Surveillance (NHBS2015) system cycle on injection drug use collected in New York City (NYC) using RDS	118 women who inject drugs were included, 40% were 50 yrs or older; Latina = 38%, Black=37%, % White=25%; (74%) reported previous incarcerated in their lifetime.	cross sectional; quantitative	PrEP awareness (e.g., Before today, have you ever heard of people who do not have HIV taking PrEP, the antiretroviral medicine taken every day for months or years to reduce the risk of getting HIV?)	Awareness of PrEP was relatively low (31%), and only 19WWID reported taking PrEP.	⊕⊕OO Observational study design with wide confidence intervals; risk of bias is low or unclear	WWID only, no race-specific analyses; hypothetical scenario;, selfreported HIV negative

Notes:

^1.PrEP: Pre-exposure prophylaxis;

^2.IDU: Injecting drug users;

^3.RDS: respondent-driven sampling;

^4.NHBS: National HIV Behavioral Surveillance;

^5.NYC: New York City;

^6.MMP: methadone maintenance program;

^7.SD: standard deviation;

^8.ACASI: Audio Computer-Assisted Self-Interviewing;

^9.WWID: Women who inject drugs;

^10.GRADE rating for quality of evidence: ⊕OOO-very low quality; ⊕⊕OO-low quality.