Promoting HIV risk reduction among people who inject drugs: A stepped care approach using contingency management with PrEP navigation

People who inject drugs (PWID) face significant barriers to accessing proven HIV prevention tools such as syringe service programs, medications for opioid use disorder, and pre-exposure prophylaxis (PrEP). In regions like Connecticut and Massachusetts, many PWID remain underserved, in part due to limited engagement with routine medical care and persistent structural challenges. Existing interventions often fail to address these layered obstacles, and there is limited evidence on strategies that effectively promote sustained PrEP adherence within this population. This research responds to the urgent need for adaptive, community-based approaches that can overcome both individual and systemic barriers to HIV prevention. The project will evaluate a stepped care intervention, CM2PN, which combines contingency management with PrEP navigation to support ongoing PrEP use and reduce HIV risk among PWID. By tailoring support based on participants’ progress, the study seeks to improve engagement in prevention, substance use treatment, and harm reduction activities. Findings could inform best practices for reaching high-risk groups and help guide implementation of flexible, resource-efficient HIV prevention strategies. Ultimately, this work aims to advance public health efforts to reduce new HIV infections in vulnerable communities.