School of Behavioral Health, Loma Linda University, Loma Linda, CA, USA.
Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA.
Sci Rep. 2023 Aug 30;13(1):14200. doi: 10.1038/s41598-023-41264-5.
Men who have sex with men (MSM) in Malaysia are disproportionately affected by HIV. As pre-exposure prophylaxis (PrEP) is being introduced, we assessed population-based PrEP delivery preferences among MSM in Malaysia. We conducted a discrete choice experiment through an online survey among 718 MSM. The survey included 14 choice tasks presenting experimentally varied combinations of five attributes related to PrEP delivery (i.e., cost, dosing strategy, clinician interaction strategy, dispensing venue, and burden of visits to start PrEP). We used latent class analysis and Hierarchical Bayesian modeling to generate the relative importance of each attribute and preference across six possible PrEP delivery programs. PrEP dosing, followed by cost, was the most important attribute. The participants were clustered into five preference groups. Two groups (n = 290) most commonly preferred on-demand, while the other three preferred injectable PrEP. One group (n = 188) almost exclusively considered cost in their decision-making, and the smallest group (n = 86) was substantially less interested in PrEP for reasons unrelated to access. In simulated scenarios, PrEP initiation rates varied by the type of program available to 55·0% of MSM. Successful PrEP uptake among Malaysian MSM requires expanding beyond daily oral PrEP to on-demand and long-acting injectable PrEP, especially at affordable cost.
马来西亚的男男性行为者（MSM）受到艾滋病毒的不成比例的影响。随着暴露前预防（PrEP）的推出，我们评估了马来西亚 MSM 对基于人群的 PrEP 提供方案的偏好。我们通过对 718 名 MSM 进行在线调查进行了离散选择实验。该调查包括 14 个选择任务，提出了与 PrEP 提供相关的五个属性的实验性变化组合（即成本、给药策略、临床医生互动策略、配药场所和开始 PrEP 的就诊负担）。我们使用潜在类别分析和分层贝叶斯模型生成每个属性和偏好在六种可能的 PrEP 提供方案中的相对重要性。PrEP 剂量，其次是成本，是最重要的属性。参与者被分为五个偏好组。两个组（n=290）最常选择按需方案，而其他三个组则更喜欢注射型 PrEP。一个组（n=188）几乎只在决策中考虑成本，而最小的组（n=86）由于与获得途径无关的原因对 PrEP 兴趣不大。在模拟情景中，根据可提供的方案类型，有 55.0%的 MSM 会改变 PrEP 的启动率。要在马来西亚 MSM 中成功推广 PrEP，需要从每日口服 PrEP 扩展到按需和长效注射型 PrEP，特别是在负担得起的成本下。
