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Variation in Preferences for Long-Acting Injectable Pre-Exposure Prophylaxis Among US Men Who Have Sex with Men: A

S Wilson Beckham¹, Travis Sanchez², Rebecca Fowler¹

¹Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

AIDS Patient Care and Stds

|October 20, 2023

Summary

Cabotegravir long-acting injectable HIV pre-exposure prophylaxis (LA PrEP) is effective. User preferences show side effects are a key concern, followed by cost and stigma, influencing uptake among men who have sex with men.

Area of Science:

Public Health
HIV Prevention
Behavioral Science

Background:

Cabotegravir long-acting injectable HIV pre-exposure prophylaxis (LA PrEP) offers an effective HIV prevention strategy with a favorable safety profile.
Understanding user preferences is crucial for optimizing the implementation and effectiveness of LA PrEP, particularly among key populations like men who have sex with men (MSM).

Purpose of the Study:

To explore potential user preferences for hypothetical long-acting injectable HIV pre-exposure prophylaxis (LA PrEP) attributes among sexually active HIV-negative MSM.
To identify distinct preference groups and understand the relative importance of factors like cost, side effects, injection frequency, stigma, and service location.

Main Methods:

An online discrete-choice experiment (DCE) was administered to 2241 HIV-negative MSM participants in the 2019 American Men's Internet Survey.
Latent class analysis was used to segment respondents based on their preferences for hypothetical LA PrEP attributes, calculating relative importance weights and willingness-to-pay.

Main Results:

73% of respondents expressed likelihood to use LA PrEP. Three distinct preference classes were identified: 'side effects-averse' (64%), 'ambivalent' (20%), and 'cost-conscious' (16%).
Perceived side effects were the most significant factor for the largest group. Cost was paramount for the 'cost-conscious' group, while stigma was more important for the 'ambivalent' group.

Conclusions:

Perceived side effects represent a significant potential barrier to LA PrEP uptake among MSM. Addressing out-of-pocket costs is vital for increasing uptake and ensuring equitable access.
Tailored communication strategies addressing specific concerns of different user segments are recommended to enhance LA PrEP implementation and effectiveness.

Keywords:

HIV/AIDS PrEP discrete-choice experiment prevention

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