Gravett Ronnie M, Long Dustin M, Biello Katie B, Mayer Kenneth H, Krakower Douglas S, Hill-Rorie Jonathan, Lillis Rebecca A, Whiteside Yohance, Elopre Latesha
Division of Infectious Diseases, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL.
Division of Public Health Sciences, Department of Biostatistics and Data Science, School of Medicine, Wake Forest University, Winston-Salem, NC.
J Acquir Immune Defic Syndr. 2025 Jun 1;99(2):128-137. doi: 10.1097/QAI.0000000000003651.
Pre-exposure prophylaxis (PrEP) cannot meaningfully affect the HIV epidemic in the United States without improving access to PrEP and reducing PrEP disparities among gay, bisexual, and other men who have sex with men (GBM), especially GBM of color. A patient-centered approach to increase PrEP options will offer better PrEP solutions to GBM. We sought to understand how GBM prefer current and emerging PrEP modalities.
We conducted a national online survey among adult GBM to determine preferences for current and emerging PrEP modalities (daily, on-demand, and monthly oral, subcutaneous and intramuscular injectable, implantable, and rectal douche) and perceived barriers, based on their lived experiences. We determined PrEP modality preferences and associations using multivariable exploded logit regression model.
In total, 723 GBM completed the survey. The largest proportion preferred monthly oral PrEP (n = 207, 28.6%), and more than half preferred some form of oral PrEP. Race was significantly associated with PrEP modality preference, and Black GBM preferred daily oral PrEP most. Side effects, health care visits, administration route, and frequency influenced PrEP preferences. PrEP and HIV knowledge, and HIV risk were associated with PrEP modality choice. GBM considered out-of-pocket cost and side effects as the significant barriers to PrEP care.
Monthly oral PrEP was most preferred with oral options preferred more than other modalities. Black GBM most preferred daily oral PrEP, which could be because of lack of familiarity with the emerging products. Future PrEP provision must include patient-centered prevention plans that include enhanced education and counseling to promote use of newer agents.
在美国，如果不能改善暴露前预防（PrEP）的可及性并减少男同性恋、双性恋和其他与男性发生性关系的男性（GBM），尤其是有色人种GBM之间的PrEP差异，PrEP就无法对艾滋病流行产生有意义的影响。以患者为中心增加PrEP选择的方法将为GBM提供更好的PrEP解决方案。我们试图了解GBM对当前和新兴PrEP方式的偏好。
我们对成年GBM进行了一项全国性在线调查，根据他们的生活经历确定对当前和新兴PrEP方式（每日、按需、每月口服、皮下和肌肉注射、植入式和直肠冲洗）的偏好以及感知到的障碍。我们使用多变量分解逻辑回归模型确定PrEP方式偏好和关联。
共有723名GBM完成了调查。最大比例的人更喜欢每月口服PrEP（n = 207，28.6%），超过一半的人更喜欢某种形式的口服PrEP。种族与PrEP方式偏好显著相关，黑人GBM最喜欢每日口服PrEP。副作用、医疗就诊、给药途径和频率影响PrEP偏好。PrEP和艾滋病毒知识以及艾滋病毒风险与PrEP方式选择有关。GBM认为自付费用和副作用是PrEP治疗的重大障碍。
每月口服PrEP最受欢迎，口服选项比其他方式更受青睐。黑人GBM最喜欢每日口服PrEP，这可能是因为对新兴产品缺乏了解。未来的PrEP提供必须包括以患者为中心的预防计划，其中包括加强教育和咨询以促进使用更新的药物。
