Research report: LAI-PrEP willingness among people who inject drugs in Appalachian Ohio: applying the Information-Motivation-Behavioral Skills Model

Only about one in three people who inject drugs in Appalachian Ohio said they would be willing to receive long-acting injectable pre-exposure prophylaxis, according to a cross-sectional survey analyzed with the Information-Motivation-Behavioral Skills model. The finding, published in AIDS Research and Therapy, comes from the Measuring Resilience study, which surveyed 250 people who inject drugs in a region where HIV remains a critical public health challenge and access to oral PrEP is limited.

For people who inject drugs, long-acting injectable PrEP could in principle overcome some of the barriers that limit PrEP access, though willingness to engage with it in this population had been uncertain. But whether this population is actually willing to accept such injections has been uncertain, which is where the new analysis begins.

Because the constructs are latent, meaning they cannot be observed directly, the researchers fit a structural equation model within a Bayesian estimation framework. In this approach, latent variables are measured through multiple observed survey items whose loadings, the strengths of the links between each item and its construct, are estimated from the data, with one loading per construct fixed to define the scale.

The measurement results show which specific survey items carried the most weight in each construct. For information, awareness of HIV prevention and awareness of HIV transmission were the important items, with loadings of 1, fixed by design, and 1.11 with a 95 percent credible interval of 0.41 to 2.46. For motivation, the important items were perceived risk of HIV and PrEP- and HIV-related stigma, with loadings ranging from 0.82, with a credible interval of 0.15 to 1.69, up to 3.89, with a credible interval of 2.23 to 6.20. For behavioral skills, the key items were confidence in attending regular appointments, with a fixed loading of 1, and confidence in managing side effects, with a loading of 0.96 and a credible interval of 0.72 to 1.28.

When the three constructs were tested as predictors of willingness to receive LAI-PrEP, behavioral skills emerged as the strongest factor, with a standardized effect of 3.71 and a 95 percent credible interval of 2.21 to 5.86. Motivation also showed a credible, positive effect, with an estimate of 1.68 and a credible interval of 0.02 to 3.69, though the interval sits just above zero, indicating a weaker and less certain association. Information, by contrast, was not associated with willingness, with an estimate of 0.22 and a credible interval spanning zero, from -0.87 to 1.41.

The pattern has a practical implication: knowing facts about HIV and PrEP, on its own, did not translate into willingness to accept the injection in this rural sample. What mattered most was whether participants felt confident they could carry out the practical demands of the regimen, such as keeping regular appointments for injections and managing side effects if they arose. Motivation, shaped by perceived HIV risk and by stigma related to PrEP and HIV, contributed as well, suggesting that attitudes and social perceptions remain part of the equation even when practical self-efficacy dominates.

The authors argue that the Information-Motivation-Behavioral Skills model is useful for understanding LAI-PrEP willingness among rural people who inject drugs, and that it can identify modifiable factors for future, locally tailored implementation programs to address. In other words, rather than treating low willingness as a fixed barrier, the framework points to specific, changeable targets, such as building appointment-keeping confidence and addressing stigma, that local programs could work on.

Several caveats frame these results. The data come from a single cross-sectional survey of 250 participants in one rural region, so the findings describe associations at one point in time rather than causal effects, and willingness measured in a survey may not predict actual uptake of injections in clinical practice. The study was published as an open access research article on 16 October 2026 in AIDS Research and Therapy, and the reported version is an accepted manuscript that may still undergo editorial changes before the final version of record appears.

Subject of Research: Willingness to use long-acting injectable HIV pre-exposure prophylaxis among people who inject drugs in Appalachian Ohio, analyzed with the Information-Motivation-Behavioral Skills model

Article Title: LAI-PrEP willingness among people who inject drugs in Appalachian Ohio: applying the Information-Motivation-Behavioral Skills Model

Article References: Enderle, M. N., Murphy, E., Murphy, J., Endres-Dighe, S. M., Nwaozuru, U., Kline, D. M., & Lancaster, K. E. (2026). LAI-PrEP willingness among people who inject drugs in Appalachian Ohio: applying the Information-Motivation-Behavioral Skills Model. AIDS Research and Therapy. https://doi.org/10.1186/s12981-026-00963-5

Image Credits: AI Generated

DOI: 10.1186/s12981-026-00963-5

Keywords: LAI-PrEP, PrEP, HIV prevention, people who inject drugs, Appalachian Ohio, Information-Motivation-Behavioral Skills model, structural equation modeling, Bayesian estimation, behavioral skills, stigma, rural health, cross-sectional survey