肯尼亚潜在用户对通过在线药店提供暴露前预防措施的偏好：一项离散选择实验。
Preferences for pre-exposure prophylaxis delivery via online pharmacy among potential users in Kenya: a discrete choice experiment.
机构信息
The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington, USA.
Vaccine and Infectious Diseases Division (VIDD), Fred Hutchinson Cancer Center, Seattle, Washington, USA.
出版信息
J Int AIDS Soc. 2024 Oct;27(10):e26356. doi: 10.1002/jia2.26356.
INTRODUCTION
Oral pre-exposure prophylaxis (PrEP) is highly effective, but coverage remains low in high HIV prevalence settings. Initiating and continuing PrEP remotely via online pharmacies is a promising strategy to expand PrEP uptake, but little is known about potential users' preferences.
METHODS
We conducted a discrete choice experiment (DCE) to assess preferences for online pharmacy PrEP services. We partnered with MYDAWA, an online pharmacy in Nairobi, Kenya. Eligibility criteria were: ≥18 years, not known HIV positive, interested in PrEP. The DCE contained four attributes: PrEP eligibility assessment (online self-assessed, guided), HIV test type (provider administered, oral HIV self-test [HIVST], blood-based HIVST), clinical consultation (remote, in-person) and user support options (text messages, phone/video call, email). Additionally, participants indicated whether they were willing to uptake their selected service. The survey was advertised on MYDAWA's website; interested participants met staff in-person at a convenient location to complete the survey from 1 June to 20 November 2022. We used conditional logit modelling with an interaction by current PrEP use to estimate overall preferences and latent class analysis (LCA) to assess preference heterogeneity.
RESULTS
Overall, 772 participants completed the DCE; the mean age was 25 years and 54% were female. Most participants indicated a willingness to acquire online PrEP services, with particularly high demand among PrEP-naive individuals. Overall, participants preferred remote clinical consultation, HIV self-testing, online self-assessment and phone call user support. The LCA identified three subgroups: the "prefer online PrEP with remote components" group (60.3% of the sample) whose preferences aligned with the main analysis, the "prefer online PrEP with in-person components" group (20.7%), who preferred in-person consultation, provider-administered HIV testing, and guided assessment, and the "prefer remote PrEP (18.9%)" group who preferred online PrEP services only if they were remote.
CONCLUSIONS
Online pharmacy PrEP is highly acceptable and may expand PrEP coverage to those interested in PrEP but not accessing services. Most participants valued privacy and autonomy, preferring HIVST and remote provider interactions. However, when needing support for questions regarding PrEP, participants preferred phone/SMS contact with a provider. One-fifth of participants preferred online PrEP with in-person components, suggesting that providing multiple options can increase uptake.
简介
口腔暴露前预防（PrEP）非常有效，但在高艾滋病毒流行地区的覆盖率仍然很低。通过在线药店远程启动和继续 PrEP 是扩大 PrEP 使用率的一种有前途的策略，但人们对潜在用户的偏好知之甚少。
方法
我们进行了一项离散选择实验（DCE），以评估对在线药店 PrEP 服务的偏好。我们与肯尼亚内罗毕的在线药店 MYDAWA 合作。合格标准为：≥18 岁，不知道 HIV 阳性，对 PrEP 感兴趣。DCE 包含四个属性：PrEP 资格评估（在线自我评估，指导），HIV 检测类型（提供者管理，口服 HIV 自我检测[HIVST]，基于血液的 HIVST），临床咨询（远程，面对面）和用户支持选项（短信，电话/视频通话，电子邮件）。此外，参与者表示是否愿意接受他们选择的服务。该调查在 MYDAWA 的网站上做广告；有兴趣的参与者在方便的地点与工作人员会面，从 2022 年 6 月 1 日至 11 月 20 日完成调查。我们使用带有当前 PrEP 使用情况交互作用的条件逻辑模型来估计总体偏好，并使用潜在类别分析（LCA）来评估偏好异质性。
结果
总体而言，772 名参与者完成了 DCE；平均年龄为 25 岁，54%为女性。大多数参与者表示愿意获得在线 PrEP 服务，特别是在 PrEP 初治个体中需求较高。总体而言，参与者更喜欢远程临床咨询、HIV 自我检测、在线自我评估和电话用户支持。LCA 确定了三个亚组：“更喜欢带有远程组件的在线 PrEP”组（样本的 60.3%），他们的偏好与主要分析一致，“更喜欢带有面对面组件的在线 PrEP”组（20.7%），他们更喜欢面对面咨询、提供者管理的 HIV 检测和指导评估，以及“更喜欢远程 PrEP（18.9%）”组，他们只愿意接受远程 PrEP 服务。
结论
在线药店 PrEP 非常受欢迎，可能会将 PrEP 覆盖范围扩大到那些有兴趣但无法获得服务的人。大多数参与者重视隐私和自主权，更喜欢 HIVST 和远程提供者的互动。然而，当需要有关 PrEP 的问题支持时，参与者更喜欢与提供者进行电话/SMS 联系。五分之一的参与者更喜欢带有面对面组件的在线 PrEP，这表明提供多种选择可以提高使用率。
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