Preferences for PrEP program attributes among Black women aged ⩾45 in the US South: A secondary analysis using...

Among Black women (BW), HIV prevalence is higher among women aged ⩾45 than among those aged <30 years. Pre-exposure prophylaxis (PrEP), a highly effective biomedical HIV prevention method, could be effective at reducing HIV incidence among this population.

To identify PrEP program features most important to aging BW and to examine how these preferences can inform program design using discrete choice experiment.

We employed secondary data analysis using a choice-based conjoint analysis (CBC), a discrete choice experiment technique.

Between June and August 2024, 390 cisgender BW were recruited online, screened for eligibility, provided e-consent, and completed a one-time CBC survey of 14 choice tasks across 6 PrEP program attributes: (1) administration method, (2) access location, (3) healthcare integration, (4) provider demographics, (5) payment options, and (6) support services. We examined PrEP program preferences only among those aged ⩾45 (N = 83 of N = 390). Hierarchical Bayes model estimated attribute importance; latent class multinomial logit analysis grouped participants by similar preferences.

PrEP administration method was the top-ranked attribute (39%), followed by provider demographics (14%) and payment options (13%). Preferences were clustered into three distinct groups. Group 1 (n = 8) showed higher proportions of worry about acquiring HIV and preferred only a daily pill by a doctor's office. Group 2 (n = 35) faced descriptively higher HIV vulnerability and favored injectable PrEP via telehealth supported (in-person) injection delivery from a female provider. Group 3 (n = 40) had the strongest interest and intention to use PrEP, preferring injectable PrEP from a pharmacist of the same race. Compared to the full sample, aging BW valued PrEP administration, prioritized gender matching alone, and payment options.

PrEP program preferences are not uniform among aging BW. Rather than relying on a single PrEP delivery model, programs should be tailored to specific preferences for aging women who consider multiple factors and may need personalized support in PrEP decision-making.