Preferences for Monthly Oral PrEP Over Other PrEP Modalities Among a National Sample of Gay, Bisexual, and Other Men Who Have Sex With Men in the United States.

Abstract

Introduction: Pre-exposure prophylaxis (PrEP) cannot meaningfully affect the HIV epidemic in the United States without improving access to PrEP and reducing PrEP disparities among gay, bisexual, and other men who have sex with men (GBM), especially GBM of color. A patient-centered approach to increase PrEP options will offer better PrEP solutions to GBM. We sought to understand how GBM prefer current and emerging PrEP modalities.

Methods: We conducted a national online survey among adult GBM to determine preferences for current and emerging PrEP modalities (daily, on-demand, and monthly oral, subcutaneous and intramuscular injectable, implantable, and rectal douche) and perceived barriers, based on their lived experiences. We determined PrEP modality preferences and associations using multivariable exploded logit regression model.

Results: In total, 723 GBM completed the survey. The largest proportion preferred monthly oral PrEP (n = 207, 28.6%), and more than half preferred some form of oral PrEP. Race was significantly associated with PrEP modality preference, and Black GBM preferred daily oral PrEP most. Side effects, health care visits, administration route, and frequency influenced PrEP preferences. PrEP and HIV knowledge, and HIV risk were associated with PrEP modality choice. GBM considered out-of-pocket cost and side effects as the significant barriers to PrEP care.

Conclusions: Monthly oral PrEP was most preferred with oral options preferred more than other modalities. Black GBM most preferred daily oral PrEP, which could be because of lack of familiarity with the emerging products. Future PrEP provision must include patient-centered prevention plans that include enhanced education and counseling to promote use of newer agents.