Preferences for HIV PrEP Products and Delivery Models Among Cisgender Men, Transgender Persons, and Non-binary Individuals Who Have Sex with Men in Seattle, Washington: A Discrete Choice Experiment.

Abstract

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-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 two hypothetical PrEP options composed of five 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: 325 participants completed the DCE; 96 (29.5%) were PrEP-naïve and 229 (70.5%) were PrEP-experienced. Ninety-nine percent efficacy (weight=0.848, 95%CI= 0.769-0.927), 6-month dosing interval (weight=0.381, 95%CI= 0.293-0.469) and pills (weight=0.173, 95%CI= 0.085-0.261) were most preferred. There was a strong preference for PrEP delivery within a pharmacy (weight=0.144, 95%CI= 0.059-0.228) or community-based organization (weight=0.097, 95%CI= 0.011-0.183). Preference for combination online/in-person (weight=0.086, 95%CI= 0.017-0.154) and in-person only monitoring appointments (weight=0.061, 95%CI= -0.023-0.144) 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 non-clinical spaces with in-person or online follow-up appointments. These data suggest that, while 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.