Preferences for implementing long-acting injectable pre-exposure prophylaxis among cisgender men who have sex with men in the US

BACKGROUND: Long-acting injectable HIV pre-exposure prophylaxis (LAI-PrEP) is efficacious and may overcome some challenges of daily oral PrEP. LAI-PrEP has great potential to reduce HIV incidence in high-risk populations, including men who have sex with men (MSM). Information about potential user preferences can be used to improve uptake, adherence, and persistence and ultimately reduce HIV incidence. We sought to understand the preferences for implementation and perceived potential barriers of LAI-PrEP among MSM.
METHODS: We recruited participants online through the 2019 American Men's Internet Survey. Eligible participants were HIV-negative, sexually active MSM aged >15 and living in the US. We designed and analyzed a discrete-choice experiment to identify preferred implementation profiles of LAI-PrEP among the respondents. Attributes included perceived side effects, injection frequency, out-of-pocket cost, service location, and negative judgement. We used mixed logit regression to calculate preference weights then relative importance by dividing the difference between the maximum and minimum preference weights within each attribute by the sum of the differences across all attributes, and multiplying by 100.
RESULTS: N=2,241 participants responded. Perceived side effects was the most important potential barrier to LAI-PrEP (52% of the total relative importance), followed by out-of-pocket cost of up to $100 (30%). Injection frequency comprised only 11% of the relative importance, with quarterly and semiannual injections slightly preferred over every 2 months. Perceived negative judgement from others (PrEP stigma) was relatively unimportant compared to other attributes (5%). Service location was the least important attribute (2%); participants only slightly preferred a private doctor's office over a sexual health clinic and a pharmacy. See Figure.
CONCLUSIONS: This analysis provides insight into potential barriers to implementation of LAI-PrEP among MSM in the US. A LAI-PrEP product with perceived severe side effects is likely to be a significant barrier to uptake, though potential users would probably tolerate mild-to-moderate side effects. Minimizing out-of-pocket costs is likely to increase uptake of LAI-PrEP and is important to equitable access to populations most at risk. Reduction of injection frequency could marginally increase likelihood of PrEP utilization. Service location and potential negative judgement are unlikely to be barriers to uptake in this population.