Patel Viraj V, Andrade Eli, Zimba Rebecca, Mirzayi Chloe, Zhang Chenshu, Kharfen Michael, Edelstein Zoe, Freeman Anthony, Doshi Rupali, Nash Denis, Grov Christian
medRxiv. 2024 May 31:2024.05.30.24308102. doi: 10.1101/2024.05.30.24308102.
PrEP uptake among Black and Latino gay, bisexual, and other men who have sex with men (GBM) remains low in the United States. The design and implementation of PrEP delivery programs that incorporate the preferences of Black and Latino GBM may overcome barriers to uptake. We aimed to identify preferences for PrEP care among high-priority GBM in the U.S. with a large discrete choice experiment.
We conducted two discreet choice experiments (DCE) to elicit care preferences for (1) Starting PrEP and (2) Continuing PrEP care among GBM clinically indicated for PrEP. The DCE web-based survey was nested in a longitudinal cohort study of GBM in the U.S., implemented with video and audio directions among 16-49 year-old participants, not using PrEP, and verified to be HIV-negative. All participants were presented with 16 choice sets, with choices determined by BLGBM and PrEP implementation stakeholders. We calculated overall utility scores and relative importance and used latent class analyses (LCA) to identify classes within the Starting and Continuing PrEP DCE. Multivariable analysis was performed to identify factors associated with class membership.
Among 1514 participants, mean age was 32 years; 46·5% identified as Latino, 21·4% Black, and 25·2 White; 37·5% had an income less than USD $20,000. Two latent classes were identified for Starting PrEP: (n=431 [28·5%]) was driven by preference for more traditional in-person care, and (n=1083 [71·5%]) preferred flexible care options and on-demand PrEP. In a multivariable model, having a sexual health doctor (adjusted OR 0·7, CI 0·5, 0·9), having a primary care provider (OR 0·7,CI 0·5, 0·9, p= 0·023), and concerns over PrEP side effects (OR 1·1, CI 1·0,1·2, p= 0·003) were all associated with class membership.
The different preferences identified for PrEP care indicate the need for diverse care and formulation choices to improve PrEP uptake and persistence. Addressing these preferences and understanding the factors that shape them can inform the implementation of programs that increase PrEP uptake.
在美国，黑人及拉丁裔男同性恋、双性恋和其他与男性发生性关系的男性（GBM）中，暴露前预防（PrEP）的使用率仍然很低。设计并实施纳入黑人及拉丁裔GBM偏好的PrEP服务项目，可能会克服PrEP使用障碍。我们旨在通过一项大型离散选择实验，确定美国高优先级GBM对PrEP护理的偏好。
我们进行了两项离散选择实验（DCE），以引出（1）开始PrEP和（2）在临床上适合PrEP的GBM中继续接受PrEP护理的护理偏好。基于网络的DCE调查嵌套在美国一项GBM的纵向队列研究中，在16 - 49岁未使用PrEP且经核实为HIV阴性的参与者中，通过视频和音频指导实施。所有参与者都被呈现16个选择集，选择由黑人、拉丁裔GBM和PrEP实施利益相关者确定。我们计算了总体效用得分和相对重要性，并使用潜在类别分析（LCA）来识别开始PrEP和继续PrEP DCE中的类别。进行多变量分析以确定与类别成员身份相关的因素。
在1514名参与者中，平均年龄为32岁；46.5%为拉丁裔，21.4%为黑人，25.2%为白人；37.5%的人收入低于20000美元。在开始PrEP方面确定了两个潜在类别：一类（n = 431 [28.5%]）由对更传统的面对面护理偏好驱动，另一类（n = 1083 [71.5%]）更喜欢灵活的护理选择和按需PrEP。在多变量模型中，有性健康医生（调整后的OR为0.7，CI为0.5，0.9）、有初级保健提供者（OR为0.7，CI为0.5，0.9，p = 0.023）以及对PrEP副作用的担忧（OR为1.1，CI为1.0，1.2，p = 0.003）均与类别成员身份相关。
所确定的对PrEP护理的不同偏好表明，需要多样化的护理和制剂选择来提高PrEP的使用率和持续性。关注这些偏好并了解形成这些偏好的因素，可以为增加PrEP使用率的项目实施提供信息。
