Ogunbajo Adedotun, Euceda Alexa, Ekundayo Raven, Smith Jamil, Oke Temitope, Hickson DeMarc
Us Helping Us, People into Living Inc., Washington D.C., District of Columbia, United States of America.
PLoS One. 2025 Jun 30;20(6):e0323212. doi: 10.1371/journal.pone.0323212. eCollection 2025.
BACKGROUND: Black sexual minority men (SMM) are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is a medication that reduces HIV acquisition. There is a gap in our understanding of the acceptability of and preference for on-demand and long-acting injectable (LAI)-PrEP among PrEP-eligible Black SMM. This study aimed to explore preference for on-demand and LAI-PrEP and reasons for those preferences among HIV-negative Black SMM of different PrEP use profiles (current PrEP users, current non-PrEP users, and PrEP discontinuers). METHODS: Between March 2022 and April 2023, we conducted 17 focus group discussions (FGDs) with a total of 58 HIV-negative (current PrEP users, non-PrEP users, and PrEP discontinuers) Black SMM residing in the Washington D.C. metropolitan area. We explored acceptability and interest in on-demand and LAI-PrEP and anticipated barriers and facilitators to uptake. RESULTS: Two key themes emerged around interest and preferences for on-demand PrEP and LAI-PrEP: 1) lack of interest in on-demand PrEP, and 2) high acceptability of LAI-PrEP. The reasons for lack of interest in on-demand PrEP were: 1) inability to accurately anticipate and plan for sexual activity in advance, 2) uncertainty about effectiveness of on-demand PrEP, and 3) potential for unnecessary medication use, especially when anticipated sexual activity doesn't occur. Most participants finding LAI-PrEP to be highly acceptable can be attributable to: 1) LAI-PrEP being convenient, and 2) LAI-PrEP being a potential solution to suboptimal adherence to daily oral PrEP due to forgetfulness. DISCUSSION: While daily oral PrEP is the most utilized PrEP modality, some SMM-who might not be acceptable to oral PrEP-are capable of accurately identifying specific periods and circumstances for HIV infection. It is important that healthcare providers present on-demand PrEP as an option to individuals who fall into these categories. Programs to increase awareness and knowledge of LAI-PrEP among Black SMM and HCP that serve them are needed. Additionally, it is imperative that HCP who provide PrEP services receive proper training on the administration of LAI-PrEP and that there is dedicated staff to help clients navigate the insurance coverage process.
背景：黑人男同性恋者（SMM）感染艾滋病毒的比例过高。暴露前预防（PrEP）是一种可降低艾滋病毒感染风险的药物。我们对符合PrEP条件的黑人男同性恋者对按需PrEP和长效注射（LAI）-PrEP的可接受性和偏好的了解存在差距。本研究旨在探讨不同PrEP使用情况（当前PrEP使用者、当前非PrEP使用者和PrEP停用者）的艾滋病毒阴性黑人男同性恋者对按需PrEP和LAI-PrEP的偏好及其原因。 方法：2022年3月至2023年4月期间，我们与居住在华盛顿特区大都市区的58名艾滋病毒阴性（当前PrEP使用者、非PrEP使用者和PrEP停用者）黑人男同性恋者进行了17次焦点小组讨论（FGD）。我们探讨了对按需PrEP和LAI-PrEP的可接受性和兴趣，以及预期的采用障碍和促进因素。 结果：围绕对按需PrEP和LAI-PrEP的兴趣和偏好出现了两个关键主题：1）对按需PrEP缺乏兴趣，2）对LAI-PrEP的高接受度。对按需PrEP缺乏兴趣的原因是：1）无法提前准确预测和计划性行为，2）对按需PrEP有效性的不确定性，3）存在不必要用药的可能性，尤其是在预期的性行为未发生时。大多数参与者认为LAI-PrEP非常可接受，这可归因于：1）LAI-PrEP方便，2）LAI-PrEP可能是解决因遗忘而导致每日口服PrEP依从性不佳的潜在方案。 讨论：虽然每日口服PrEP是最常用的PrEP方式，但一些可能无法接受口服PrEP的男同性恋者能够准确识别艾滋病毒感染的特定时期和情况。医疗保健提供者向属于这些类别的个人提供按需PrEP作为一种选择非常重要。需要开展相关项目，以提高黑人男同性恋者和为他们服务的医疗保健提供者对LAI-PrEP的认识和了解。此外，提供PrEP服务的医疗保健提供者必须接受关于LAI-PrEP给药的适当培训，并且要有专门的工作人员帮助客户处理保险覆盖流程。
N Engl J Med. 2021-8-12
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