Systematic Development of Discrete Choice Experiment Attributes to Assess PrEP Preferences Among MSM and Transgender...

Men who have sex with men (MSM) and transgender women (TGW) in the United States face a high burden of HIV, but the uptake of preexposure prophylaxis (PrEP) remains low. With long-acting injectable PrEP, now with Food and Drug Administration-approved and newer formulations entering clinical use, our study developed attributes for a discrete choice experiment to capture PrEP access preferences in Baltimore. Nested within a mixed method project, five focus groups (21 MSM and two TGW) informed attribute development using a four-step framework: data collection, thematic coding, attribute reduction, and refinement. Guided by the Gelberg-Andersen model and a systematic review, 50 themes were reduced to six attributes. Choice sets were pilot tested with nine participants. The six attributes were modality/effectiveness, side effects, provider environment, dispensing location, support monitoring, and cost/insurance. Pilot testing confirmed usability. This rigorous, community-informed process produced attributes, reflecting structural and personal factors influencing PrEP decision making, now integrated into a cross-sectional survey to guide equitable service delivery.