Table 2.

Primary Themes for HIV Prevention and PrEP Uptake among Rural PWID Mapped to PRISM Domains.

PRISM domain	PRISM element activated	Theme	Example quote
Recipients, client characteristics	Knowledge and beliefs	Need for HIV information	There ain't no AIDS around here. If there is and they're made aware of that.
		Uncertain personal risk	I get scared thinking if I got it, I don't know if I want to find out.
	Disease burden	Substance use disorder situational risks	When you are sick and withdrawing there's no line you won't cross.
Program (intervention), client perspectives	Addresses client barriers	Stigma: social rejection and harms from systems	The stigma would be like that. You wouldn't want somebody to know you're taking it [PrEP] because they think you have HIV.
		Scarce physical capital: pervasive economic distress	Sometimes I might miss a week cause I ain't got, my ride got tore up and you know, you might not find a ride up here.
	Access	SSP utilization: safety, inclusion supports expanded care opportunities	I felt like that I was being taken care of, that someone cared enough that I didn't have to shoot with used needles.
	Client-centered	Health management: resilience, empowerment, readiness	I had it [HCV]. And then I took the Mavyret and got rid of it. I took three pills a day for two months.