Interest in Long-Acting Preexposure Prophylaxis (PrEP) Among Men at Risk for Human Immunodeficiency Virus Who Use Methamphetamine Participating in a Daily, Oral PrEP Adherence Trial in San Francisco, California.

Background: Methamphetamine use is associated with increased risk for human immunodeficiency virus (HIV) and suboptimal adherence to daily, oral preexposure prophylaxis (PrEP). Long-acting PrEP is a promising HIV prevention method for people who use methamphetamine. Methods: We conducted interviews with participants of a daily, oral PrEP adherence trial at their final visit. Participants were assigned male at birth and reported past-month methamphetamine use and past-year condomless sex with a partner with HIV or unknown status. We conducted a thematic analysis of interview transcripts to assess experiences with daily, oral PrEP and interest in long-acting PrEP. Results: Of 23 participants, median age was 42 (interquartile range, 33-48) years, all were cisgender men, most were White (73%), and approximately half had been homeless or lived in a shelter in the past year (52%). The most common daily, oral PrEP adherence challenges were forgetting to take the medication, followed by not having the medication available and competing priorities. Most participants (91%) were interested in long-acting PrEP. A plurality (43%) preferred injection as the modality, 39% preferred a long-acting pill, and 17% an implant. Most concerns about long-acting PrEP regarded the implant, including the length of time drug is in the body and the insertion/removal procedure; frequent clinic visits were another concern. Conclusions: Most participants who used methamphetamine were interested in and described barriers to daily medications that could be mitigated by long-acting PrEP. Injections were the most preferred modality, although long-acting oral PrEP alleviated concerns for some. Future research should assess optimization of long-acting PrEP delivery to this at-risk population.