Optimizing Uptake of Long-Acting Injectable Pre-exposure Prophylaxis for HIV Prevention for Men Who Have Sex with Men

Abstract

Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention tool. Long-acting injectable PrEP (LAI-PrEP) offers another opportunity to reduce HIV. However, how at-risk individuals will consider LAI-PrEP over other modes of administration is unclear. We conducted a discrete choice experiment on preferences for PrEP among a sample of N = 688 gay, bisexual, and other men who have sex with men (GBMSM). We analyzed preferences for mode of administration, side-effects, monetary cost, and time cost using a conditional logit model and predicted preference for PrEP options. LAI-PrEP was preferred, despite mode of administration being the least important PrEP attribute. Side-effects were the most important attribute influencing preferences for PrEP (44% of decision); costs were second-most-important (35% of decision). PrEP with no side-effects was the most important preference, followed by monthly out-of-pocket costs of $0. Practitioners and policymakers looking to increase PrEP uptake should keep costs low, communicate clearly about PrEP side-effects, and allow the use of patient-preferred modes of PrEP administration, including LAI-PrEP.

Oral Pre-Exposure Prophylaxis Accessibility, Knowledge, Barriers, and Facilitators Among Men Who Have Sex With Men in Bulawayo, Zimbabwe

“…The most commonly identified barriers include stigma on PrEP users being promiscuous and HIV positive, their sexuality, inadequate information on PrEP, negative attitudes from PrEP providers, daily pill taking, fear of side effects, and inadequate coverage of PrEP. The findings correspond with many studies identifying the aforementioned barriers (Adeagbo et al, 2021;Dean et al, 2023;Klein & Washington, 2020;Pichon et al, 2022;Pingel et al,…”

Oral Pre-exposure Prophylaxis Uptake and Acceptability Among Men Who Have Sex With Men: A Scoping Review of the Literature

“…Literature has identified that a majority of MSM do not take PrEP due to fear of unforeseen side effects of PrEP, which might be long-term (Gredig et al, 2016). The cost The availability of PrEP facilitates willingness to use it (Ahouada et al, 2020;Frankis et al, 2016) Availability of PrEP influences its uptake (Ahouada et al, 2020;Chakrapani et al, 2015;Dean et al, 2023;Diabaté et al, 2021;Galea et al, 2011;Kimani et al, 2022;Pelletier et al, 2019) Preference for PrEP to be accessible at MSM networks (Ahouada et al, 2020;Graham et al, 2023;Harawa et al, 2016;Pelletier et al, 2019) Accessibility of IEC material on PrEP increases knowledge and awareness of PrEP (Graham et al, 2023) Inaccessibility to PrEP influences low uptake (Adeagbo et al, 2021;Han et al, 2019;Harawa et al,…”

“…Negative attitudes from health care workers (Adeagbo et al, 2021;Graham et al, 2023;Holloway et al, 2017;Patrick et al, 2019) Lack of confidentiality by health care providers (Graham et al, 2023) Mistrust of health system and pharmaceutical companies (Adeagbo et al, 2021;Chakrapani et al, 2015;Holloway et al, 2017;Liu et al, 2017;Philbin et al, 2016) Uncomfortable talking about sexuality or PrEP with health care providers (Holloway et al, 2017;Patrick et al, 2019;Yu et al, 2021) Not accessible or inadequate coverage (Blair et al, 2022;Han et al, 2019;Harawa et al, 2016;Holloway et al, 2017;Kota et al, 2021;Patrick et al, 2019;Pichon et al, 2022) Cost / high pricing of PrEP (Chakrapani et al, 2015;Dean et al, 2023;Emmanuel et al, 2020;Galea et al, 2011;Graham et al, 2023;Gredig et al, 2016;Han et al, 2019;Harawa et al, 2016;Hojilla et al, 2018;Holloway et al, 2017;Kota et al, 2021;Mansergh et al, 2012;Patrick et al, 2019;Pérez-Figueroa et al, 2015;Voglino et al, 2021) Restrictive and complex procedure for drug procurement (Ahouada et al, 2020;Diabaté et al, 2021;Liu et al, 2017) Long distance to PrEP facilities (transport cost)…”

“…Pill-related factors Concern about daily pill taking (Galea et al, 2011;Graham et al, 2023;Grant et al, 2014;Holloway et al, 2017;Klein & Washington, 2020;Pelletier et al, 2019;Pingel et al, 2017) Same packaging of PrEP as ART (Graham et al, 2023) Pill size, taste, odor (Diabaté et al, 2021;Pelletier et al, 2019) Effectiveness, safety, and side effects Perceiving PrEP to be ineffective and its inefficacy (Cox et al, 2021;Diabaté et al, 2021;Graham et al, 2023;Gredig et al, 2016) Fear of side effects (Arnold-Forster et al, 2022;Bekker et al, 2022;Blair et al, 2022;Dean et al, 2023;Diabaté et al, 2021;Emmanuel et al, 2020;Graham et al, 2023;Grant et al, 2014;Gredig et al, 2016;Han et al, 2019;Holloway et al, 2017;Klein & Washington, 2020;Kota et al, 2021;Liu et al, 2017;Patrick et al, 2019;Pelletier et al, 2019;Philbin et al, 2016;Voglino et al, 2021;Yu et al, 2021) Possible drug interactions with medications the person already takes (Emmanuel et al, 2020;Klein & Washington, 2020) Risk Perception Low-risk perception (Blair et al, 2022;Chakrapani et al, 2015;Cox et al, 2021;Emmanuel et al, 2020;Graham et al, 2023;…”

“…The study identified some facilitators that improve PrEP use among MSM, thus providing policymakers with information they could use to make informed decisions about ensuring the effectiveness of the PrEP programs. In general, MSM preferred free PrEP, and it was associated Information-related factors PrEP education and dissemination of information, that is, social media, IEC (Graham et al, 2023;Harawa et al, 2016;Pichon et al, 2022) Health care provider-related factors Existence of MSM-friendly facilities (Graham et al, 2023;Pichon et al, 2022;Yu et al, 2021) Location of the facilities and citing of PrEP services (Graham et al, 2023;Kimani et al, 2022) Delivery services of PrEP (Kimani et al, 2022;Pelletier et al, 2019) Support from health care providers (Ahouada et al, 2020;Diabaté et al, 2021;Galea et al, 2011) Increase health care centers that provide PrEP services (Harawa et al, 2016) Availability of cheap or free PrEP (Ahouada et al, 2020;Chakrapani et al, 2015;Dean et al, 2023;Diabaté et al, 2021;Galea et al, 2011;Kimani et al, Support groups or PrEP clubs (Graham et al, 2023;Harawa et al, 2016;Zhou et al, 2022) Support from partners, including HIV-positive partners (Graham et al, 2023) Access to counseling (Ahouada et al, 2020;Pichon et al, 2022) Privacy and disclosure Drop-in centers for MSM (Graham et al, 2023) The belief that the partner would not find out (Chakrapani et al, 2015) Desire, motivation, and risk perception Perceived to be high-risk (Graham et al, 2023;Hoagland et al, 2017;Liu et al, 2017;Wang et al, 2018) Perceived benefits and feeling safe of PrEP (Galea et al, 2011;Graham et al, 2023;…”