The awareness and preferences in PrEP access, type of service delivery, and willingness to pay among men who have sex with men in the Philippines: a discrete choice experiment.

Abstract

Background The Philippines has witnessed a 550% increase in HIV cases between 2010 and 2023, disproportionately affecting men who have sex with men (MSM). Despite the national rollout of pre-exposure prophylaxis (PrEP) in 2021, uptake remains limited, with structural and individual barriers, such as PrEP-associated cost and stigma influencing engagement. This study explores Filipino MSM's preferences for PrEP service attributes to inform person-centered HIV prevention strategies. Methods A cross-sectional online survey, as part of the PrEP APPEAL multicountry study, was conducted among MSM in the Philippines in May to November 2022. A discrete choice experiment embedded in the survey assessed preferences for six PrEP service attributes, including type, access location, cost, side-effects, visit frequency and additional services. Preferences were analyzed using random parameters logit and latent class models. Results Among 2282 MSM respondents (mean age=28.8years, s.d.=7.9), 68.9% had heard of PrEP, yet only 18.3% were current users. In the pooled analysis, cost, PrEP type, and side-effects were the most influential attributes. MSM preferred free oral PrEP but willing to pay up to Philippine Peso (PHP) 1000 (AUD 25) per month (β =0.06, P =0.032), services accessed through community-led clinics (β =0.12, P =0.001), and yearly clinic visits (β =0.14, P Conclusions Despite growing awareness, uptake among Filipino MSM remains limited. Findings highlight diverse user preferences, reinforcing the need for differentiated, person-centered PrEP models. Expanding community-based access, ensuring affordability and integrating user-informed features can optimize uptake, whereas sustainable financing and phased rollout of newer modalities are essential for national scale-up.