Preferences for Pre-exposure Prophylaxis (PrEP) among people who use drugs in Thailand: A discrete choice experiment.

BACKGROUND

Pre-exposure prophylaxis (PrEP) is effective in preventing HIV. However, engaging people who use drugs (PWUDs) in PrEP services remains challenging due to societal, legal, and structural barriers. This study examined preferences for PrEP services among people who use drugs in Thailand.

METHODS

We conducted a discrete choice experiment (DCE) using a self-administered paper-based questionnaire from March to August 2024 at Thanyarak Chiang Mai Hospital. PWUDs were identified through hospital records. Random Parameters Logit (RPL) models were used to explore the drivers of PrEP use. RPL models with interactions examined heterogeneity in preferences for PrEP, and Latent Class Models identified subgroups with similar preferences for PrEP.

RESULTS

Among 210 respondents, 87 % were male and had a mean age of 33 (±8.5) years. Cost was the most important attribute, followed by location, the friendliness of service providers, the types of PrEP and privacy. PWUDs expressed less preference with PrEP services offered at Key Population Led Health Services (KPLHS), services exclusively catering to PWUDs, with no significant preferences for other locations, interactions with unempathetic or inattentive staff, and services costing 200 THB (US$ 5.6) or 500 THB (US$ 14.1) per month. Compared to their counterparts, those unaware of PrEP were more likely to access the service through TelePrEP, while females preferred accessing PrEP through Key Population Led Health Services. Latent class model revealed that 29 % of respondents tended to favor TelePrEP, while the majority (71 %) were less likely to use PrEP services through Key Population Led Health Services or services provided by unfriendly staff.

CONCLUSIONS

Diverse PrEP provisions considering service location, the friendliness of service providers, and free access could improve PrEP uptake among people who use drugs. Developing innovative service delivery models that address group-specific preferences is essential.