Preferences for HIV Pre-exposure Prophylaxis among Gay, Bisexual, and Men Who Have Sex with Men in China: a Discrete Choice Experiment.

Abstract

Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV in gay, bisexual, and other men who have sex with men (GBMSM). This study investigates PrEP usage and preferences among Chinese GBMSM and how key attributes influence their choices using a discrete choice experiment (DCE). Six PrEP attributes were evaluated: dosing frequency, dispensing venue, side effects, effectiveness, follow-up frequency, and extra services. From January to November 2022, a face-to-face survey was conducted among 1186 GBMSM in Xi'an, China. Multi- and mixed-logit models assessed preferences and heterogeneity by demographics. Latent class analysis examined unobserved preference patterns, and scenario analysis explored how changes in attributes affect PrEP acceptance. Among 995 valid participants (mean age 34 ± 9 years), 20.5% had ever used PrEP. The most influential attribute was dosing frequency, followed by side effects and follow-up frequency. Participants preferred on-demand PrEP, private dispensing venues, minimal side effects, at least 60% effectiveness, follow-up every 3 months, and comprehensive STI testing. Preferences varied by age, education, and income. Latent class analysis indicated 57.04% of participants preferred on-demand PrEP, STD/social health clinics, very low-risk kidney complications, 80% effectiveness, 3-month follow-up, and no extra services. Scenario analysis showed on-demand PrEP and 80% effectiveness would increase acceptance by 73.6% and 43.2%, respectively, compared to daily oral PrEP and 30% effectiveness. Conversely, switching from daily oral pills to bi-monthly injections decreased acceptance by 48.2%. Dosing frequency is the most influential attribute for HIV PrEP among Chinese GBMSM. Preferences vary by demographics, and reduced dosing and improved effectiveness may substantially boost uptake.