Preferences for HIV preexposure prophylaxis care among gay, bisexual, and other MSM: a large discrete choice experiment.

objectiveWe aimed to identify preferences for preexposure prophylaxis (PrEP) care among diverse gay, bisexual, and other MSM (GBM) in the United States with discrete choice experiment (DCE).

designWe conducted two DCEs to elicit care delivery preferences for starting and continuing PrEP among 16-49-year-old GBM who were HIV-negative and not using PrEP from across the United States. DCEs assessed preferences for care options including location, formulation (pills, injectable), lab testing, and costs. Participants completed 16 choice tasks, and utility scores and relative importance were estimated. We performed latent class analyses to identify groups within each DCE, and multivariable logistic regression to identify sociodemographic characteristics associated with class membership.

resultsAmong 1514 participants, 46.5% identified as Latino, 21.4% Black, and 25.2 White. For Starting PrEP DCE, two latent classes were identified: 'In-Person' (28.5%), which preferred in-person care and lab testing, and 'Virtual' (71.5%), which preferred telehealth and at-home lab testing. For Continuing PrEP DCE, two latent classes were identified: 'Pills' (23.6%), which preferred oral PrEP with low-cost options and 'No cost/injectable' (76.4%), which strongly preferred no-costs and injectable PrEP. In multivariable models for Starting PrEP and for Continuing PrEP, latent class membership was significantly associated with a range of sociodemographic characteristics, including race/ethnicity, income, housing instability, and provider and PrEP stigma.

conclusionThe preferences identified for PrEP care in this diverse GBM sample indicate the need for multiple care and formulation choices, including elimination of costs to improve PrEP uptake. DCE findings can guide implementation efforts to improve equitable access to PrEP.