Interest in and Preference for Long-Acting Injectable Pre-exposure Prophylaxis Among Men Who Have Sex With Men, Trans* Individuals, and Cisgender Heterosexual Women: A Global Systematic Review and Meta-Analysis.

BACKGROUND

Long-acting injectable pre-exposure prophylaxis (LAI-PrEP) offers potentials for expanding PrEP coverage and improving public health outcomes. This study synthesizes evidence on the prevalence and determinants of interest in and preference for LAI-PrEP among men who have sex with men (MSM), trans* individuals, and heterosexual women.

METHODS

We conducted this systematic review and meta-analysis building on quantitative studies from a previous review and new studies published in PubMed, Web of Science, and Embase up to December 31, 2023. We used a random-effects meta-analysis to pool the prevalence of LAI-PrEP interest and preference, and narratively synthesized their determinants across all key populations.

FINDINGS: We included 41 articles. Seventy-four percentage (95% CI: 71 to 78) of MSM showed interest in using LAI-PrEP, and 37% (95% CI: 29 to 44) of them preferred LAI-PrEP over other HIV prevention methods. The prevalence of interest and preference were even higher among current oral PrEP users [77% (95% CI: 70 to 84) and 43% (95% CI: 28 to 58), respectively]. Interest in LAI-PrEP among trans* individuals was similarly high at 72% (95% CI: 67 to 78), with 1 study reporting that 57% of transgender women preferred LAI-PrEP. Cisgender heterosexual women also showed a high preference for LAI-PrEP (55%, 95% CI: 40 to 70). No significant differences were found between low-/middle-income countries and high-income countries across any key populations. Overall, people with more resources and who are already aware of and using oral PrEP are likely more interested in LAI-PrEP when it becomes available.

CONCLUSIONS

Continued research is essential to effectively deploy LAI-PrEP and address HIV prevention gaps. Because more countries adopt LAI-PrEP, understanding its impact and reaching underserved populations will be critical to maximizing public health benefits.