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Identifying HIV PrEP Attributes to Increase PrEP Use Among Different Groups of Gay, Bisexual, and Other Men Who Have Sex with Men: A Latent Class Analysis of a Discrete Choice Experiment

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Abstract

Daily pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV among gay, bisexual, and other men who have sex with men (GBMSM), although uptake remains suboptimal. By identifying the features of PrEP that appeal to various subgroups of GBMSM, this study aimed to improve PrEP uptake by examining preferences for PrEP use. Adults ≥ 18 years old in six New England states completed an online discrete choice experiment survey. A latent class analysis (LCA) was conducted to identify groups of GBMSM based on four attributes of choices for PrEP (cost, time, side effects, and mode of administration). Multinominal logistic regression was conducted to compare the association between sociodemographic and behavioral characteristics and class memberships. Data from 675 GBMSM were analyzed. A 3-Class model was selected as the best fit model. Class 1 (47.7% of individuals) was identified as having “no specific preferences”. Class 2 (18.5% of individuals) were “Cost- and time-conscious” and were significantly more likely to be older, have prior sexually transmitted infection (STI) testing, have low household income, private insurance, and have extreme concerns about HIV risk than those with no specific preference (Class 1). Finally, Class 3 (34.1% of individuals) were “Side effects-conscious” and were more likely to have low income, private insurance, and have moderate and extreme concerns about HIV risk than those with no specific preference (Class 1). Findings indicate that outreach to GBMSM who have never used PrEP should emphasize low cost and short travel times to increase potential PrEP use.

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Funding

This research is supported by awards from the National Institute of Mental Health, Award Numbers: R21MH118019-01 and R25MH083620, the National Institute of Allergy and Infectious Disease, Award Number: T32AI102623 from the National Institutes of Health as well as Johns Hopkins University Center for AIDS Research, Award Number: P30AI094189.

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Authors and Affiliations

  1. Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA

    Rahel Dawit & Lorraine T. Dean

  2. RAND Health Care, RAND Corporation, Boston, MA, 02116, USA

    Zachary Predmore

  3. Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, 02118, USA

    Julia Raifman & Alexandra Skinner

  4. Brown University AIDS Program, The Miriam Hospital, Providence, RI, 02906, USA

    Philip A. Chan, Siena Napoleon, Alexandra Zanowick-Marr, Danielle Le Brazidec & Alexi Almonte

  5. Division of Infectious Diseases, Department of Medicine, Alpert Medical School of Brown University, Providence, RI, 02903, USA

    Philip A. Chan

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  1. Rahel Dawit
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Contributions

RD: conceptualization, data analysis, writing—original, review and editing, final approval. ZP: Data cleaning, data analysis, writing—review and editing, final approval. JR and PAC: conceptualization, writing—review and editing, final approval. AS, SN, AZ-M, DLB, and AA: data cleaning, writing—review and editing, final approval. LTD: conceptualization, data analysis, writing—review and editing, final approval.

Corresponding author

Correspondence to Rahel Dawit.

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The authors declare that they have no competing interests. The content is solely the responsibility of the authors and does not necessarily represent the view of the National Institute of Health.

Ethical Approval

This study was approved by the Miriam Hospital Institutional Review Board.

Informed Consent

Informed consent forms were provided to study participants in both English and Spanish, and written informed consent was obtained from study participants prior to beginning the study. Those who were not able to provide consent were not enrolled in the study.

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Dawit, R., Predmore, Z., Raifman, J. et al. Identifying HIV PrEP Attributes to Increase PrEP Use Among Different Groups of Gay, Bisexual, and Other Men Who Have Sex with Men: A Latent Class Analysis of a Discrete Choice Experiment. AIDS Behav 28, 125–134 (2024). https://doi.org/10.1007/s10461-023-04131-y

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