Interest in Long-Acting Preexposure Prophylaxis (PrEP) Among Men at Risk for Human Immunodeficiency Virus Who Use...

Methamphetamine use is associated with increased risk for human immunodeficiency virus (HIV) and suboptimal adherence to daily, oral preexposure prophylaxis (PrEP). Long-acting PrEP is a promising HIV prevention method for people who use methamphetamine.

We conducted interviews with participants of a daily, oral PrEP adherence trial at their final visit. Participants were assigned male at birth and reported past-month methamphetamine use and past-year condomless sex with a partner with HIV or unknown status. We conducted a thematic analysis of interview transcripts to assess experiences with daily, oral PrEP and interest in long-acting PrEP.

Of 23 participants, median age was 42 (interquartile range, 33-48) years, all were cisgender men, most were White (73%), and approximately half had been homeless or lived in a shelter in the past year (52%). The most common daily, oral PrEP adherence challenges were forgetting to take the medication, followed by not having the medication available and competing priorities. Most participants (91%) were interested in long-acting PrEP. A plurality (43%) preferred injection as the modality, 39% preferred a long-acting pill, and 17% an implant. Most concerns about long-acting PrEP regarded the implant, including the length of time drug is in the body and the insertion/removal procedure; frequent clinic visits were another concern.

Most participants who used methamphetamine were interested in and described barriers to daily medications that could be mitigated by long-acting PrEP. Injections were the most preferred modality, although long-acting oral PrEP alleviated concerns for some. Future research should assess optimization of long-acting PrEP delivery to this at-risk population. Clinical Trials Registration. NCT04523519.