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Center for Aids Research (CFAR) Development Award


Opioid use has risen at an alarming rate in recent years. This epidemic of opioid misuse and abuse has led to increased numbers of people who inject drugs (PWID), placing new populations at increased risk for HIV. In North Carolina, the rate of HIV is four times higher than the national average and over 10% of all HIV prevalent cases are attributable to injection drug use (IDU). While there is limited data on the number of PWID and associated increases or decreases in IDU over time, recent trends in overdose deaths and hepatitis C (HCV) rates can shed some light on the current prevalence. In North Carolina, heroin deaths have risen 565% over the past four years and HCV cases have more than doubled.


The overarching goal of the proposed project was to identify barriers and facilitators of PrEP uptake, adherence and implementation from both the provider and individual perspectives in Guilford County, NC. The project provided a unique opportunity to engage a high-need, underserved population


A major aim of the study was to gauge the knowledge and interest, barriers and facilitators, and provision preferences of PWID who are and are not syringe exchange clients. This aim will be achieved by engaging in qualitative interviews with current syringe exchange clients and with PWID who are not syringe exchange clients.

A second aim of the study was to assess provider and community-based harm reduction staff’s interest and understanding of PrEP, barriers and facilitators to implementing PrEP programs for PWID, and to obtain ideas related to packaging PrEP as a harm reduction tool. This aim was achieved by completing interviews with medical and harm reduction staff including: HIV medical providers, PrEP providers, syringe exchange outreach workers, community health workers, and other harm reduction staff.


The project provided a unique opportunity to engage a high-need, underserved population. Syringe exchange was recently legalized in NC and is among the very first in the South. This project connected with those who are engaging in syringe exchange and those who are not, which are populations from which important HIV prevention preferences can be gained.

Finally, the findings of this project will illuminate the best ways to tailor PrEP provision for PWID in the South, an understudied population. Particularly important is the opportunity to examine the acceptability and feasibility of packaging PrEP as a harm reduction tool to be deployed in combination with syringe outreach.

Study Team/Roles

  • Lauren Brinkley-Rubinstein, PhD, Assistant Professor (UNC-CH), PI
  • William Zule, DrPH, MPH, Senior Health Analyst (RTI International), co-mentor
  • Carol Golin, MD,  Associate Professor (UNC-CH), co-mentor
  • Elizabeth Costenbader, PhD, Social Scientist (FHI 360), co-mentor

Funding Organization

The funding organization was the UNC Center for AIDS Research.

The grant lasted for one year from January to December of 2018.


  • Hershow, R., Gonzalez, M., Costenbader, B., Golin, C., Zule, W., & Brinkley-Rubinstein, L. (2019). Medical providers and harm reduction views on Pre-Exposure Prophylaxis for HIV prevention among people who inject drugs. AIDS Education and Prevention. 31(4). 363-379. doi: 10.1521/aeap.2019.31.4.363.
  • Rhodes B., Costenbader, B., Wilson, L., Hershow, R., Carroll, J., Zule, W., & Brinkley-Rubinstein, L. (2019). Urban, individuals of color are impacted by fentanyl-contaminated heroin. International Journal of Drug Policy. 19 (73).1-6. doi: 10.1016/j.drugpo.2019.07.008.


  • Brinkley-Rubinstein, L. (2019, October). Incarceration as a Social Determinant of Health. Invited talk at University of Buffalo, Buffalo, NY.
  • Brinkley-Rubinstein, L. (2019, March). HIV infection among people who are incarcerated. Invited talk at the Southeast AIDS Education and Training Center coordinated by Vanderbilt University, Nashville, TN.
  • Brinkley-Rubinstein, L. (2018, October). Opioid use among incarcerated populations. Invited talk at St. Louis University, St. Louis, MO.


Lauren Brinkley-Rubinstein |

333 S. Columbia St.

341b MacNider Hall

Chapel Hill, NC 27599

Learn More

Center for AIDS Research Developmental Award webpage


Last updated; 7/28/2020