Understanding PrEP Preferences in a Select Population

When people are considering a newer therapy, they will weigh the potential benefits against their concerns. Barriers to usage can include costs, side effects, frequency of administration, and in some cases, stigma. Sometimes these barriers remain too much for people, and prevents them from beginning a regimen.

PrEP is certainly a therapy that warrants consideration before beginning it. While overall it has seen an increase in usage every year, it has not realized a widespread utilization in candidates who could benefit from it. According to the US Centers for Disease Control and Prevention, as many as 1.1 million Americans could benefit from PrEP, including 175,000 women and 780,000 people of color.

Yet, statistics on usage remains low compared to the prospective benefactors.

According to AIDSVu, there were only 77,120 PrEP users in the US in 2016. They also found that there was a 73 percent increase year over year in persons using PrEP across the US from 2012 to 2016. Although this would suggest a growing trend in the right direction, its obvious many more people could take advantage of the therapy.

And it does not appear to be an issue of awareness with PrEP. A team of investigators conducted a survey of 202 young, minority men and transgender women to try and gain an understanding as to why some individuals were more likely to take PrEP than others. Findings from the study demonstrated that 98% of the participants were aware of PrEP, but less than 25% were currently taking it.

Additional findings showed that there were racial and ethnic differences in certain factors associated with the use of PrEP. While White participants likelihood of using PrEP increased with age, participants of color were more likely to take the therapy if they were given information by a healthcare provider and if they had positive beliefs about using it.

With the prospective addition of long-acting injectables for PrEP in the near future, having another treatment option that requires less administration may make it is easier to maintain and therefore lead to greater utilization. Investigators associated with Johns Hopkins, Emory’s Rollins School of Public Health, and ViiV Healthcare surveyed the MSM population to gain insights into their attitudes towards the therapy as well as the concerns associated with taking it.

Principal investigator of the survey, S. Wilson Beckham, PhD, MPH, MA, assistant scientist, Department of Health, Behavior and Society, and Department of International Health—Social & Behavioral Sciences, Johns Hopkins Bloomberg School of Public Health, is presenting his study, Variation in Preferences for Long-Acting Injectable PrEP Among US Men who Have Sex with Men: a Latent Class Analysis, virtually at the 11th IAS Conference on HIV Science.

The investigators used the the 2019 American Men’s Internet Survey (AMIS). This annual, cross-sectional online survey has been ongoing since 2013, has approximately 10,000 cisgender men ages 15+ living in the US recruited per cycle, and they identify as gay, bisexual, and/or reported sex with men.

They added a few questions geared towards attitudes and preferences about long-acting injectable PrEP.

They matched potential barriers or disutility against each other. For example, they took side effects against another barrier, such as costs, to find out in a series of questions which has greater disutility. “The methodology I used was the discreet choice experiment,” Beckham explained. “It is a quantitative way of measuring preferences and trading off those preferences against each other.”

They then added another layer using a pattern of the participants’ responses with the aid of a computer’s artificial analysis to help identify the men into three classes, which included a cost-conscious class; the side effects class; and the stigma class. These classes categorized the greatest concerns for survey participants.

Contagion spoke to Beckham to learn more about the methodology in their survey, gain further insights into the various classes of men, and understanding the respondents’ concerns about injectables.