Preferences for pre-exposure prophylaxis service package among men who have sex with men in Australia: a discrete choice experiment.

Objectives: Pre-exposure prophylaxis (PrEP) usage remains below the Australian 75% coverage target. This study identified preferences for PrEP services shared among subgroups of men who have sex with men (MSM) living in Australia and explored heterogeneity preferences across different age groups and countries of birth.

Methods: MSM aged>18 years with no prior HIV diagnosis and residing in Australia completed an online discrete choice experiment between May and November 2022. The attributes included type of PrEP, service location, service cost, PrEP side effects, visit frequency and additional services. Participants were recruited through dating apps, Facebook and local MSM community organisations. We used a latent class model (LCM) to explore subgroups with similar preferences for PrEP programmes and a random parameters logit model with interactions to explore heterogeneity preferences.

Results: Overall, 1894 MSM participated, with a mean age of 40 (±12) years. The LCM identified four groups of MSM who shared similar preferences for PrEP services: 'Long-acting oral or injectable PrEP from community clinics' (22% of participants), 'Daily oral PrEP from pharmacies' (5%), 'Long-acting oral PrEP from pharmacies' (52%) and 'injectable PrEP from the hospital' (22%). The group preferring injectable PrEP (22%) preferred accessing PrEP services at hospitals offering sexually transmitted infection testing every 6 months, with a willingness to pay a small fee ($A25). They were willing to endure mild pain at the injection site as a side effect of injectable PrEP. Compared with Australian-born, overseas-born MSM preferred PrEP services offering injectable PrEP. Compared with younger MSM, MSM over 30 years old preferred services offering daily PrEP.

Conclusions: There is a growing demand for alternatives to oral daily PrEP, with a significant group preferring services including long-acting oral or injectable PrEP and willing to pay a small fee to access it. The majority preferred decentralising access to PrEP through pharmacies. Diverse preferences for PrEP service delivery signify tailored PrEP implementation initiatives to increase PrEP coverage among underserviced populations.