Willingness and preferences for long-acting injectable PrEP among US men who have sex with men: a discrete choice experiment

• Published in: BMJ open Vol. 14; no. 4; p. e083837
• Main Authors: Cole, Sam Wilson, Glick, Jennifer L, Campoamor, Nicola B, Sanchez, Travis H, Sarkar, Supriya, Vannappagari, Vani, Rinehart, Alex, Rawlings, Keith, Sullivan, Patrick S, Bridges, John F P
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 22.04.2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Adolescent; Adult; Anti-HIV Agents - administration & dosage; Anti-HIV Agents - therapeutic use; Choice Behavior; Delayed-Action Preparations; Diketopiperazines; Disease prevention; Ethnicity; Experiments; FDA approval; Gays & lesbians; health economics; HIV; HIV & AIDS; HIV Infections - prevention & control; Homosexuality, Male - psychology; Human immunodeficiency virus; Humans; Injections; Literature reviews; Male; Men; Mens health; Middle Aged; Patient Acceptance of Health Care - statistics & numerical data; Patient Preference - statistics & numerical data; Pre-Exposure Prophylaxis - methods; public health; Pyridones - administration & dosage; Qualitative research; sexual and gender minorities; Sociodemographics; Surveys and Questionnaires; United States; Young Adult; United States; United States > US; sexual and gender minorities; HIV & AIDS; public health; health economics
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-083837

IntroductionCabotegravir long-acting injectable HIV pre-exposure prophylaxis (LA-PrEP) was shown to be safe and effective in multiple clinical trials. Increasing uptake and persistence among populations with elevated risk for HIV acquisition, especially among men who have sex with men (MSM), is critical to HIV prevention.ObjectiveThis analysis aims to understand potential users’ preferences for LA-PrEP, with audience segmentation.DesignWillingness to use and preferences for LA-PrEP were measured in HIV-negative, sexually active MSM in the 2020 American Men’s Internet Survey. Respondents answered a discrete choice experiment with paired profiles of hypothetical LA-PrEP characteristics with an opt-out option (no LA-PrEP). Conditional and mixed logit models were run; the final model was a dummy-coded mixed logit that interacted with the opt-out.SettingUS national online sample.ResultsAmong 2506 MSM respondents, most (75%) indicated a willingness to use LA-PrEP versus daily oral PrEP versus no PrEP. Respondents were averse to side effects and increasing costs and preferred increasing levels of protection. Respondents preferred a 2-hour time to obtain LA-PrEP vs 1 hour, with a strong aversion to 3 hours. Overall, there was an aversion to opting out of LA-PrEP, with variations: those with only one partner, no/other insurance or who were Black, Indigenous or People of Colour were significantly less likely to prefer LA-PrEP, while those who were Hispanic/Latino, college educated and <40 years significantly preferred LA-PrEP.ConclusionsA large proportion of MSM expressed a preference for LA-PrEP over daily oral pills. Most respondents chose LA-PrEP regardless of cost, clinic time, side effects or protection level; however, preferences varied by sociodemographics. These varied groups likely require tailored intervention strategies to achieve maximum LA-PrEP uptake and persistence.