Preferences for PrEP Program Attributes Among Black Women Across the Southern United States: A Discrete Choice Experiment.

BACKGROUND

HIV disproportionately affects cisgender Black women (CBW), yet fewer than 2% of eligible CBW use preexposure prophylaxis (PrEP); an effective biomedical HIV prevention method. To improve PrEP uptake, this study identified CBW's preferences for key features of PrEP delivery programs using a discrete choice experiment (DCE).

METHODS

CBW were recruited, screened online, and completed a one-time DCE survey. Participants completed 14 choice tasks involving 6 PrEP program attributes: (1) administration method, (2) access location, (3) health care integration, (4) provider demographics, (5) payment options, and (6) support services. Hierarchical Bayes models estimated attribute importance; latent class analysis was used to group participants by similar preferences.

RESULTS

Among 390 participants, administration method was the top-ranked attribute (48%), followed by provider demographics (13.2%), and access location (12%). Preferences clustered into 5 groups. Group 1 (n = 82), younger women with high educational attainment, preferred telehealth initiated bi-monthly injectable PrEP. Group 2 (n = 82), older women with lower HIV vulnerability, favored oral and injectable PrEP prescribed by a physician during women's health visits. Group 3 (n = 108) had the highest HIV vulnerability, showed strong interest in PrEP, preferred the vaginal ring accessed through pharmacies or telehealth. Group 4 (n = 59) had the lowest access to health care, preferred injectable PrEP in clinical settings with income-based cost adjustments. Group 5 (n = 59), 1 of the youngest and economically advantaged, favored the vaginal ring from a pharmacy.

CONCLUSIONS

Findings indicate administration method, provider type, and access location mattered most to CBW for PrEP programming, indicating the need to use multiprong approaches to bolster PrEP uptake.