PrEParing for NextGen: Cognitive Interviews to Improve Next Generation PrEP Modality Descriptions for Young Men Who have Sex with Men

Biello, Katie B.; Valente, Pablo K.; Lin, Willey Y.; Drab, Ryan; Hightow-Weidman, Lisa; Silva, Daniel Teixeira da; Mayer, Kenneth H.; Bauermeister, José A.

doi:10.1007/s10461-021-03545-w

Cited by 10 publications

(5 citation statements)

References 35 publications

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“…Familiarity with next‐generation products was not measured. Although we used descriptions of the products developed and tested in cognitive interviews with YMSM [ 34 ], preferences may differ if or when the products are available. Lastly, the conjoint experiments were designed to examine preferred features and willingness to pay for product features; however, because each participant was randomized to review one product, we could not quantitatively compare feature preferences across products.…”

Section: Discussionmentioning

confidence: 99%

“…Definitions of PrEP products and images for the product features were reviewed by participants prior to the conjoint experiment. Definitions and images were developed through cognitive interviews with YMSM (reported previously [ 34 ]). Given that many of the products are still under development, and that we were trying to assess optimal attributes, we did not include the frequency of recommended use in the descriptions (e.g.…”

Section: Methodsmentioning

confidence: 99%

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Who prefers what? Correlates of preferences for next‐generation HIV prevention products among a national U.S. sample of young men who have sex with men

Biello,

Valente,

da Silva

et al. 2023

J Int AIDS Soc.

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Introduction Pre‐exposure prophylaxis (PrEP) has been available for young people for over a decade, yet only ∼15% of young people in the United States with indications for PrEP have a prescription for it. Next‐generation PrEP modalities may address some of the challenges of daily oral PrEP. However, preferences for these products are unknown. Methods From October 2020 to June 2021, we conducted an online survey of 737 cisgender, young men who have sex with men (age 15–24 years) without HIV across the United States who reported same‐sex attraction or consensual sex with another man in the past 6 months. Participants completed a conjoint experiment comparing daily oral pills, event‐driven oral pills, event‐driven rectal douches, intramuscular injections, intravenous broadly neutralizing antibody (bnAb) infusions and subcutaneous implants. Participants ranked the products from most to least preferred. Exploded logit models examined the association between ranked preferences of PrEP modalities and socio‐demographic and behavioural characteristics. Results Participants’ mean age was 21 years (SD = 2.3), and 56% identified as White. Nineteen percent were currently taking daily oral PrEP, and another 9% had previously taken it. Participants prioritized efficacy, absence of side effects and costs in the conjoint analyses. Daily oral PrEP had the highest preference ranking, followed by event‐driven oral (OR = 0.89, p = 0.058), injectable (OR = 0.83, p = 0.005), implant (OR = 0.48, p < 0.0001), bnAb infusions (OR = 0.38, p < 0.0001) and rectal douches (OR = 0.24, p < 0.0001). There were differences in PrEP preferences across age, insurance status, sexual behaviour, PrEP use history, HIV and sexually transmitted infection (STI) testing history, and STI diagnoses (omnibus tests: p < 0.05). Participants also provided reasons for selecting their top product choice: ease of use for those who chose daily oral (99%) and daily event‐driven (98.5%); feel more protected against HIV for those who chose injectable (95.4%) and implants (100%); not worrying about forgetting to take it for those who chose bnAbs (93.8%); and being able to stop taking it when they want for those who chose rectal douche (90.9%). Conclusions Next‐generation modalities were less likely to be preferred over daily oral PrEP, with differences in the magnitude by socio‐demographic and behavioural characteristics. Given the low uptake of daily oral PrEP, end‐users’ preferences for and concerns about PrEP products must be understood to ensure high acceptability and penetration.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Who prefers what? Correlates of preferences for next‐generation HIV prevention products among a national U.S. sample of young men who have sex with men

Biello,

Valente,

da Silva

et al. 2023

J Int AIDS Soc.

Self Cite

View full text Add to dashboard Cite

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“…These were issues touched upon by participants but could not be expanded upon enough to reach thematic saturation. Several studies have suggested that there is no single preference that reflects the needs of all individuals in given community; therefore, future research and interventions should provide education about the diversity of all PrEP technologies to promote informed decision-making for YMSM of color (Bauermeister et al, 2020; Biello et al, 2022; Biello, Valente, et al, 2018; Martinez et al, 2022). Targeted rollout of LAI PrEP must include careful education for clients about clinician-administered injections, as well as risk mitigation strategies for missed doses so that this PrEP innovation actually benefits those who need it.…”

Section: Discussionmentioning

confidence: 99%

Exploring Stigma, Resilience, and Alternative HIV Preventive Service Delivery Among Young Men who Have Sex with Men of Color

et al. 2023

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Stigmatization on the basis of race, sexuality, gender identity, and/or use of pre-exposure prophylaxis (PrEP) exacerbates HIV disparities for young men who have sex with men of color (YMSM). We explored resilience, healthcare experiences, stigma, and impact of coronavirus disease 2019 (COVID-19) on PrEP care needs among YMSM of color through virtual in-depth interviews. Analyses used adapted grounded theory/constant comparison. Regarding healthcare-based stigma, participants enacted multilevel resilience which was critical to their care retention during COVID-19 (Themes 1 and 2). Some participants noted that remote care could minimize healthcare stigma and promote retention in care and/or on PrEP (Theme 3). Participants were interested in long-acting injectable (LAI) PrEP but expressed concerns about cost, effectiveness, and side effects (Theme 4). Community-based venues like pharmacies were preferred spaces for getting LAI PrEP injections (Theme 4). Although expansion of telehealth that helped mitigate care retention challenges during COVID-19 was temporary, continued telehealth use may reduce stigmatization and promote long-term retention and PrEP persistence.

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“…attributes; e.g. 50% effective; 80% effective; 95% effective) that may affect intended users' uptake of these products [7,21]. This manuscript describes MTN-035 participants' choice trade-offs after having the opportunity to use each of three rectal placebo modalities (i.e.…”

Section: Introductionmentioning

confidence: 99%

A conjoint experiment of three placebo rectal products used with receptive anal sex: results from MTN‐035

Bauermeister,

Lin,

Tingler

et al. 2024

J Int AIDS Soc.

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IntroductionEnd‐user perspectives are vital to the design of new biomedical HIV prevention products. Conjoint analysis can support the integration of end‐user perspectives by examining their preferences of potential pre‐exposure prophylaxis (PrEP) products. The Microbicides Trial Network (MTN) 035 protocol examined three placebo rectal dosage forms (insert, enema and suppository) that could deliver PrEP prior to receptive anal sex (RAS).MethodsBetween April 2019 and July 2020, we enrolled 217 HIV‐negative, cisgender men who have sex with men (MSM; n = 172; 79.3%) and transgender people (n = 47; 20.7%) ages 18–35 into a randomized cross‐over trial across Malawi, Peru, South Africa, Thailand and the United States. Participants used each product prior to RAS over 4‐week periods. Participants completed a conjoint experiment where they selected between random profiles using seven features (dosage form, timing of use before sex, side effects, duration of protection, effectiveness, frequency of use and need for a prescription).ResultsEffectiveness was the strongest determinant of choice (30.4%), followed by modality (18.0%), potential side effects (17.2%), frequency of use (10.8%), duration of protection (10.4%), timing of use before sex (7.4%) and need for a prescription (5.9%). Relative utility scores indicated that the most desirable combination of attributes was a product with 95% efficacy, used 30 minutes before sex, offering a 3‐ to 5‐day protection window, used weekly, having no side effects, in the form of an enema and available over‐the‐counter.ConclusionsChoice in next‐generation PrEP products is highly desired by MSM and transgender people, as no one‐size‐fits‐all approach satisfies all the preferences. MTN‐035 participants weighed product features differently, recognizing the need for diverse, behaviourally congruent biomedical options that fit the needs of intended end‐users.

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PrEParing for NextGen: Cognitive Interviews to Improve Next Generation PrEP Modality Descriptions for Young Men Who have Sex with Men

Cited by 10 publications

References 35 publications

Who prefers what? Correlates of preferences for next‐generation HIV prevention products among a national U.S. sample of young men who have sex with men

Who prefers what? Correlates of preferences for next‐generation HIV prevention products among a national U.S. sample of young men who have sex with men

Exploring Stigma, Resilience, and Alternative HIV Preventive Service Delivery Among Young Men who Have Sex with Men of Color

A conjoint experiment of three placebo rectal products used with receptive anal sex: results from MTN‐035

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