JMIR Publications

ABSTRACT

Background:

Oral pre-exposure prophylaxis (PrEP) is a highly effective strategy for HIV prevention, but its real-world impact depends on sustained adherence. Long-acting injectable cabotegravir (CAB-LA) offers a new prevention option that may reduce the burden of daily or event-driven pill use. In China, a substantial proportion of real-world oral PrEP users obtain PrEP through online platforms. However, evidence remains limited on awareness of and willingness to use CAB-LA among oral PrEP users in this real-world access context.

Objective:

This study aimed to assess awareness of and willingness to use CAB-LA and to identify associated factors among real-world oral PrEP users in China.

Methods:

The study used baseline data from the Real-world E-consumer Cohort of Oral PrEP (RECOPE), a prospective longitudinal cohort established in China between December 2023 and June 2024. Participants were real-world oral PrEP users who accessed PrEP through an online platform and were surveyed using an anonymous, self-administered online questionnaire. The questionnaire assessed awareness of and willingness to use CAB-LA, barriers and facilitators to use CAB-LA, sociodemographic characteristics, HIV risk behaviors, PrEP-related variables, and sexually transmitted disease (STD) history. Logistic regression models were applied to identify factors associated with awareness and willingness.

Results:

Among 621 oral PrEP users (mean age=29.9 years), 35.8% (n=226) had heard of CAB-LA, whereas 68.9% (n=428) reported willingness to use it. Convenience was the predominant reason for willingness to use (92.3%), while concerns about cost were the most common reason for unwillingness (63.7%). In multivariable analyses, participants who had switched oral PrEP regimens were more likely to be aware of CAB-LA (aOR=1.59, 95% CI: 1.08-2.33). Willingness to use CAB-LA was positively associated with engagement in chemsex (aOR=1.58, 95% CI: 1.04-2.40), correct oral PrEP-related knowledge (aOR=1.22, 95% CI: 1.03-1.46), a history of STD (aOR=2.52, 95% CI: 1.18-5.40), and less PrEP-related stigma (aOR=0.97, 95% CI: 0.94-0.99).

Conclusions:

Conclusion Among real-world oral PrEP users in China, awareness of CAB-LA was limited, whereas willingness to use it was high. Individuals with higher HIV-related risk and more favorable PrEP-related perceptions were more willing to use CAB-LA. These findings provide early evidence on awareness of and willingness to use CAB-LA among real-world oral PrEP users in China and may inform future research and implementation planning. Clinical Trial: none