JMIR Publications

ABSTRACT

Background:

Long-acting (LA) injectable PrEP and on-demand PrEP may improve overall PrEP uptake among men who have sex with men (MSM), but little is understood about the PrEP option preferences of MSM in practical scenarios where they may choose between various PrEP options.

Objective:

Preferences for starting various PrEP options were examined among a US nationwide online convenience sample of MSM collected September 2021 to February 2022.

Methods:

Participants reporting no prior HIV diagnosis were given brief descriptions of each PrEP option and were asked “If [PrEP option] were available from your local doctor and you could access it for free, would you go to your doctor in the next month to start [PrEP option]?” Those who said ‘yes’ to multiple options were asked to rank them in order of preference. MSM currently taking daily oral (DO) PrEP were asked whether they would switch to on-demand or LA PrEP options. Log binomial models were created to examine the association between willingness to start/switch to on-demand and LA PrEP with various sociodemographic and behavioral factors.

Results:

Among participants who did not use any PrEP in the past 12 months (n=4545), 53.8 % reported willingness to start at least one PrEP option and 40.6 % of participants showed interest in starting multiple PrEP options. Overall, the highest willingness was reported for on-demand PrEP (43.8 %), followed by daily oral PrEP (42.6 %) and LA PrEP (29.0 %). LA PrEP was ranked first among those interested in multiple options. Characteristics associated with ranking LA PrEP as a first option to start PrEP versus DO or on-demand PrEP were region of residence (residing in the West versus Northeast), report of STI diagnosis in the past year, report of illicit drug use in the past year, and prior awareness of LA PrEP. Among current daily oral PrEP users (n=2353), 58 % were willing to switch to on-demand or LA PrEP and LA PrEP was ranked first among participants who were open to switch to both options. Willingness to switch to LA PrEP was higher among those who used illicit drugs in the past year, who heard of LA PrEP prior to the survey and who took ≤15 doses of oral PrEP in last 30 days.

Conclusions:

LA PrEP was the highest ranked option among the majority of MSM who were open and willing to try multiple options or switch from daily oral PrEP. These findings highlight that LA PrEP might fill coverage gaps among MSM who use illicit drugs, have had a recent STI diagnosis, and those who had less than optimal daily oral PrEP adherence. Clinical Trial: N/A