Exploring user preferences for PrEP service delivery models in Japan: a discrete choice experiment among men who have sex with men

High cost and limited PrEP providers impede PrEP uptake for Japanese users. Our study aims to investigate PrEP use behaviors and preferences for PrEP among men who have sex with men (MSM) in Japan.

PrEP APPEAL was an online cross-sectional survey conducted in Japan to assess PrEP preferences among adult MSM using a discrete choice experiment design. Data were collected between May 2022 and November 2022. Participants were primarily recruited through gay dating apps and community-based referral. Mixed logit modeling with effects coding was applied to estimate preference weightings and individual segments with heterogeneous preferences.

A total of 1358 participants were included (mean age 39.3 years, s.d. 11.2 years); 98.5% were assigned male at birth, and 78.4% identified as gay men. Only 13.5% were current PrEP users. Participants ranked monthly service cost (46.2%) as the most important PrEP attribute, followed by side effects (21.7%), PrEP type (14.5%), access locations (6.3%), visit frequency (5.8%) and additional services (5.6%). They were highly sensitive to cost increases (β = -0.33, P < 0.001), preferred options with no side effects (β = 0.63, P < 0.001) and comprehensive STI testing (β = 0.19, P < 0.001). On-demand (β = 0.32, P < 0.001) and monthly oral dosing (β = 0.34, P < 0.001) were preferred, whereas slow-release implants were less preferred (β = -0.49, P < 0.001). Care through MSM-operated clinics (β = 0.21, P < 0.001) or pharmacies (β = 0.12, P = 0.047) was preferred over hospitals (β = -0.15, P = 0.031). Longer visit intervals of 6 months (β = 0.11, P = 0.015) or annually (β = 0.11, P = 0.006) were preferred over shorter intervals.

Affordable PrEP options with minimal side effects and care provision through community-led clinics are generally preferred by Japanese MSM. Developing a decentralized PrEP delivery model that aligns with user preferences is essential to help Japan accelerate its goals to end the HIV epidemic by 2030.