Interest in HIV pre-exposure prophylaxis use and associated factors among people who inject drugs in Iran: a nationwide survey in 2023.

Despite the effectiveness of pre-exposure prophylaxis (PrEP) in reducing HIV incidence, this intervention is inaccessible in Iran. We examined the interest in using PrEP and associated factors among people who inject drugs (PWID) in 2023 using data from 2,174 PWID. The main outcome was interest in using PrEP, which was divided into three categories: interest in using PrEP under any circumstances, interest in using PrEP if provided for free, and no interest in using PrEP. We found that 37.9% of PWID were interested in using PrEP under any circumstances, 48.3% were interested in using PrEP if provided for free, and 13.8% were not interested in using PrEP. Additionally, only 7.7% of participants reported prior awareness of PrEP. Having high school or more education (adjusted relative risk ratios [ARRR]: 1.92; 95% confidence interval [CI]: 1.42, 2.61), having access to opioid agonist treatment (OAT) in the last six months (ARRR: 1.59; 1.13, 2.25), and having sufficient HIV knowledge (ARRR: 2.87; 2.03, 4.06) were positively associated with interest in using PrEP under any circumstances. Similarly, having high school or more education (ARRR: 1.50; 1.10, 2.04), having access to OAT in the last six months (ARRR: 2.63; 1.88, 3.67), and having sufficient HIV knowledge (ARRR: 4.53; 3.23, 6.37) were associated with interest in using PrEP if provided for free. Health insurance was negatively associated with interest in using PrEP under any circumstances (ARRR: 0.64; 0.47, 0.87) and with interest in using PrEP if provided for free (ARRR: 0.33; 0.23, 0.45). The findings show a strong potential for PrEP acceptance, indicating that addressing financial and logistical barriers to free PrEP access could greatly reduce HIV incidence among PWID in Iran.