PrEP Product Acceptability and Dual Process Decision-Making Among Men Who Have Sex with Men

Advances in short- and long-acting pre-exposure prophylaxis (PrEP) technologies have incentivized the need to understand how individuals make trade-offs and competing decisions regarding PrEP modalities. The purpose of this review was to examine how researchers have conceptualized and measured attributes that are either intuitive and emotional (System 1) or deliberative and cognitive (System 2) in conjoint analysis or discrete choice experiments focused on diverse PrEP technologies among men who have sex with men (MSM).

Across the 9 studies meeting inclusion criteria, 5 included oral PrEP, 3 included topical rectal microbicides, 4 included PrEP injectables, and 1 study focused on an HIV prevention vaccine. Studies have not used uniform metrics, making comparisons difficult. Researchers measured attributes linked to System 2 processing (e.g., cost, efficacy), yet none examined System 1 processing. There is not one product or attribute preferable to all groups. Prevention products will need to be developed and promoted to reflect that diversity. Given that PrEP technologies have been solely informed by System 2 attributes, efforts to integrate System 1 attributes into ongoing and future PrEP choice experiments are pivotal to advance PrEP acceptability research and interventions to support their implementation.