Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Emory University Rollins School of Public Health, Atlanta, Georgia, USA.
AIDS Patient Care STDS. 2023 Oct;37(10):495-503. doi: 10.1089/apc.2023.0109.
Cabotegravir long-acting injectable HIV pre-exposure prophylaxis (LA PrEP) is efficacious, with a good safety profile, and was approved by the US Food and Drug Administration in December 2021. Understanding variations in potential user preferences for LA PrEP may inform implementation and subsequently improve uptake and community-level effectiveness. HIV-negative, sexually active men who have sex with men (MSM) aged ≥15 years were recruited online for the 2019 American Men's Internet Survey, before LA PrEP approval. Respondents completed a discrete-choice experiment (DCE) with hypothetical LA PrEP attributes (out-of-pocket cost, perceived side effects, injection frequency, perceived stigma, service location). Latent class analysis segmented respondents into groups based on their preferences for the attributes presented, and relative importance of preference weights and willingness-to-pay were calculated. While the majority had never used daily oral PrEP, 73% of the 2489 respondents were very or somewhat likely to use LA PrEP. Three latent classes were identified from 2241 respondents in the DCE. The "side effects-averse" class was the largest group (64% of respondents) and placed 61% relative importance on side effects. The "ambivalent" class (20% of respondents) placed higher importance on stigma (17% of relative importance) than other classes. The "cost-conscious" class (16% of respondents) placed higher relative importance (62%) on cost compared with other attributes and classes. Perceived side effects were an important hypothetical barrier for LA PrEP uptake among a large proportion of potential MSM users. Minimizing out-of-pocket costs is likely to increase uptake and may be important to equitable access. Tailored communication strategies are recommended for the different groups of potential LA PrEP users.
卡博特韦长效注射型 HIV 暴露前预防（LA PrEP）具有疗效好、安全性好的特点，并于 2021 年 12 月获得美国食品和药物管理局批准。了解潜在使用者对 LA PrEP 的偏好差异，可能有助于实施，并随后提高使用率和社区层面的效果。在 LA PrEP 获得批准之前，2019 年美国男性互联网调查招募了年龄≥15 岁、有性行为的 HIV 阴性男男性行为者（MSM）进行在线调查。受访者完成了一项关于 LA PrEP 假设属性（自付费用、感知副作用、注射频率、感知耻辱感、服务地点）的离散选择实验（DCE）。潜在类别分析根据受访者对呈现属性的偏好将其分为不同的组别，并计算偏好权重和支付意愿的相对重要性。虽然大多数人从未使用过每日口服 PrEP，但 2489 名受访者中有 73%非常或有点可能使用 LA PrEP。从 2241 名 DCE 受访者中确定了三个潜在类别。“厌恶副作用”类别是最大的组别（占受访者的 64%），对副作用的相对重要性为 61%。“矛盾”类别（占受访者的 20%）对耻辱感的重视程度高于其他类别（相对重要性为 17%）。“关注成本”类别（占受访者的 16%）对成本的相对重要性（62%）高于其他属性和类别。感知副作用是 LA PrEP 被大量潜在 MSM 使用者接受的一个重要假设障碍。降低自付费用可能会增加使用率，对于公平获得可能很重要。建议为不同类别的潜在 LA PrEP 用户制定有针对性的沟通策略。
