Women's Global Health Imperative, RTI International, Berkeley, CA.
RTI Health Solutions, RTI International, Durham, NC.
J Acquir Immune Defic Syndr. 2021 Jul 1;87(3):928-936. doi: 10.1097/QAI.0000000000002670.
Long-acting pre-exposure prophylaxis (LA-PrEP) formulated as implants and injections are promising prevention method strategies offering simplicity, discretion, and long dose duration. Men are important end users of LA-PrEP, and early assessment of their preferences could enhance downstream male engagement in HIV prevention.
A discrete-choice experiment survey was conducted with 406 men, aged 18-24, in Cape Town, South Africa, to assess preferences for 5 LA-PrEP attributes with 2-4 pictorially-depicted levels: delivery form, duration, insertion location, soreness, and delivery facility. Latent class analysis was used to explore heterogeneity of preferences and estimate preference shares.
The median age was 21 (interquartile range 19-22), and 47% were men who have sex with men. Duration was the most important product attribute. Latent class analysis identified 3 classes: "duration-dominant decision makers" (46%) were the largest class, defined by significant preference for a longer duration product. "Comprehensive decision makers" (36%) had preferences shaped equally by multiple attributes and preferred implants. "Injection-dominant decision makers" (18%) had strong preference for injections (vs. implant) and were significantly more likely to be men who have sex with men. When estimating shares for a 2-month injection in the buttocks with mild soreness (HPTN regimen) vs. a 6-month implant (to arm) with moderate soreness (current target), 95% of "injection-dominant decision makers" would choose injections, whereas 79% and 63% of "duration-dominant decision makers" and "comprehensive decision makers" would choose implant.
Young South African men indicated acceptability for LA-PrEP. Preferences were shaped mainly by duration, suggesting a sizeable market for implants, and underscoring the importance of product choice. Further research into men's acceptability of LA PrEP strategies to achieve engagement in these HIV prevention tools constitutes a priority.
长效暴露前预防（LA-PrEP）的植入和注射制剂是很有前途的预防方法策略，它们具有简单、谨慎和长效的特点。男性是 LA-PrEP 的重要终端使用者，对他们偏好的早期评估可以增强男性对 HIV 预防措施的后续参与度。
在南非开普敦，对 406 名年龄在 18-24 岁的男性进行了一项离散选择实验调查，以评估对 5 种 LA-PrEP 属性的偏好，这些属性具有 2-4 个图像描绘的水平：给药形式、持续时间、插入位置、疼痛和给药设施。潜在类别分析用于探索偏好的异质性并估计偏好份额。
中位年龄为 21 岁（四分位距 19-22 岁），47%为男男性行为者。持续时间是最重要的产品属性。潜在类别分析确定了 3 个类别：“持续时间主导决策者”（46%）是最大的类别，他们显著偏好更长的持续时间产品。“综合决策者”（36%）的偏好受到多个属性的同等影响，更喜欢植入物。“注射主导决策者”（18%）强烈偏好注射（而非植入物），且更有可能为男男性行为者。当估计臀部注射 2 个月（HPTN 方案）与中度疼痛（手臂）6 个月植入物（目前的目标）的份额时，95%的“注射主导决策者”会选择注射，而 79%和 63%的“持续时间主导决策者”和“综合决策者”会选择植入物。
南非年轻男性表示接受 LA-PrEP。偏好主要由持续时间决定，这表明对植入物有相当大的市场，突出了产品选择的重要性。进一步研究男性对 LA PrEP 策略的可接受性，以实现对这些 HIV 预防工具的参与，是当务之急。
