Preferences for HIV Pre-Exposure Prophylaxis Products and Delivery Models Among Cisgender Men, Transgender Persons, and Nonbinary Individuals Who Have Sex With Men in Seattle, Washington: A Discrete Choice Experiment.

BACKGROUND

Understanding preferences for HIV pre-exposure prophylaxis (PrEP) products and delivery models could better meet the needs of populations likely to benefit from PrEP and ultimately increase uptake.

SETTING

Public Health-Seattle & King County Sexual Health Clinic.

METHODS

Between August 2022 and December 2023, a convenience sample of individuals seeking HIV testing and participating in Project DETECT2 completed a discrete choice experiment (DCE). We used a D-efficient blocked fractional design and asked participants to choose between 2 hypothetical PrEP options composed of 5 attributes (modality, efficacy, dosing frequency, prescriber, and monitoring appointment format). We used multinomial logistic regression to estimate preference weights and relative importance overall and stratified by PrEP experience.

RESULTS

Three hundred twenty-five participants completed the DCE; 96 (29.5%) were PrEP naive and 229 (70.5%) were PrEP experienced. Ninety-nine percent efficacy (weight = 0.848, 95% CI: 0.769 to 0.927), 6-month dosing interval (weight = 0.381, 95% CI: 0.293 to 0.469), and pills (weight = 0.173, 95% CI: 0.085 to 0.261) were most preferred. There was a strong preference for PrEP delivery within a pharmacy (weight = 0.144, 95% CI: 0.059 to 0.228) or community-based organization (weight = 0.097, 95% CI: 0.011 to 0.183). Preference for combination online/in-person (weight = 0.086, 95% CI: 0.017 to 0.154) and in-person only monitoring appointments (weight = 0.061, 95% CI: -0.023 to 0.144) was similar. Efficacy had the highest relative importance (52.1%). Stratifying by PrEP experience did not change preference.

CONCLUSIONS

Participants preferred products with high efficacy and longer dosing intervals delivered in nonclinical spaces with in-person or online follow-up appointments. These data suggest that, although highly efficacious, longer acting products are preferred, a range of different modalities, prescribers, and monitoring methods may be needed to reach everyone who may benefit from PrEP.