Yale School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA.
National Clinician Scholars Program, University of California, San Francisco, 3333 California St., San Francisco, CA, 94118, USA.
J Urban Health. 2022 Apr;99(2):277-292. doi: 10.1007/s11524-022-00615-9. Epub 2022 Mar 22.
The use of pre-exposure prophylaxis (PrEP) for HIV prevention within the U.S. military is low. Implementing preference-based alternative modalities of PrEP delivery, however, can be an innovative strategy to address the specific barriers to PrEP uptake among military MSM. We sought to identify population-based, segment-specific preferences for longer-acting and alternative PrEP delivery modalities to guide patient-centered strategies to optimize uptake within military-serving healthcare systems. HIV-negative military men who have sex with men (MSM) completed an anonymous, adaptive choice-based conjoint (ACBC) analysis survey consisting of five key attributes of interest (dosing method, provider type, visit location, lab work evaluation location, and dispensing venue). Relative importance and part-worth utility scores were generated using Hierarchical Bayes (HB) estimation, and cluster ensemble analysis grouped participants into "phenotype" segments by preference similarity. The randomized first-choice model was then used to examine changes in program interest rates among segments through market simulation. The 429 participants were segmented into five preference groups. The dosing method attribute was found to be the most important to nearly all segments. Simulations revealed that PrEP program interest among two segments with low interest levels increased when smartphone, civilian-based, and long-acting injectable PrEP options were involved. Findings also suggested a need for clinics to be responsive and sensitive to sexual practices, risk perception, and functional PrEP knowledge. Responsiveness to segment-specific preferences in the design of military PrEP programs and acting on the importance of clinical relationships within the context of PrEP engagement within a military setting may contribute to increasing PrEP uptake.
在美国军队中，使用暴露前预防（PrEP）来预防艾滋病毒的使用率较低。然而，实施基于偏好的替代 PrEP 提供方式可以是一种创新策略，可以解决军队男男性行为者（MSM）中 PrEP 采用的具体障碍。我们旨在确定基于人群的、特定细分市场对长效和替代 PrEP 提供方式的偏好，以指导以患者为中心的策略，优化军队服务医疗保健系统内的采用率。完成匿名、自适应选择基础联合（ACBC）分析调查的 HIV 阴性军队 MSM，调查包括五个感兴趣的关键属性（给药方法、提供者类型、就诊地点、实验室工作评估地点和配药地点）。使用层次贝叶斯（HB）估计生成相对重要性和部分价值效用评分，并通过集群集成分析根据偏好相似性将参与者分为“表型”细分市场。然后使用随机第一选择模型通过市场模拟检查细分市场中的计划利率变化。429 名参与者被分为五个偏好组。结果发现，几乎所有细分市场中，给药方法属性是最重要的。模拟结果表明，当涉及智能手机、基于平民的和长效注射 PrEP 选项时，两个兴趣水平较低的细分市场对 PrEP 计划的兴趣增加。研究结果还表明，诊所需要对性行为、风险认知和功能性 PrEP 知识做出反应和敏感。在军事 PrEP 计划的设计中，针对细分市场的偏好做出响应，并在军事环境中 PrEP 参与的背景下重视临床关系，可能有助于提高 PrEP 的采用率。
