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  11th IAS Conference on HIV Science 18-21 July 2021
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US MSM Seem Eager for Injectable
PrEP-Side Effects, Cost Biggest Concerns

  IAS 2021, 11th IAS Conference on HIV Science, July 18-21, 2021
Mark Mascolini
Almost three quarters of US men who have sex with men (MSM) called themselves very or somewhat likely to use long-acting injectable (LAI) PrEP in a 2241-man internet survey [1]. Half of survey respondents cited avoiding severe side effects as their major concern, while 30% worried about cost.
HPTN 083 demonstrated the superiority of every-8-week cabotegravir injections over daily oral tenofovir/emtricitabine in preventing HIV infection among at-risk men and transgender women who have sex with men [2,3]. Authorities expect licensing of injected cabotegravir for PrEP in the United States and elsewhere, according to Johns Hopkins University researchers and collaborators who presented results of the internet survey at IAS 2021 [1].
The survey aimed to explore facilitators and barriers to LAI PrEP uptake by gay, bisexual, and other MSM. To address these questions, Will Beckham of Johns Hopkins University and coworkers at other centers turned to the American Men’s Internet Survey (AMIS), an annual online cross-sectional survey of about 10,000 cisgender men at least 15 years old. The survey used discrete-choice experiment (DCE) methodology [4], which allows respondents to rate LAI-PrEP attributes (like side effects and out-of-pocket expense) by levels (like low, medium, and high concern about side effects and $0, $25, or $100 for out-of-pocket expenses) and so to avoid head-to-head comparisons of attributes.
Among men who responded to the LAI-PrEP survey, 64% were younger than 30, 63% were white, 78% had some university education, and 60% were urban or suburban. A large majority, 84%, had 2 or more male sex partners, 73% had condom-free anal sex, and 14% had a sexually transmitted infection diagnosis. About one quarter, 28%, used PrEP currently or in the past, and 76% said they were willing to try PrEP.
The biggest proportion of 2241 respondents, about 43%, said they were very likely to use LAI-PrEP, while about 29% were somewhat likely, about 10% neutral, under 10% somewhat unlikely, and about 10% very unlikely.
Respondents viewed the two most important attributes of LAI-PrEP as avoiding severe side effects (52%) and avoiding $100 out-of-pocket costs (30%). Less frequent injections emerged as a moderately important attribute (11%), while less important attributes were PrEP-related stigma (5%) and location of services (2%).
Men who answered the survey were willing to pay much more to reduce severe side effects ($84) than for other LAI-PrEP attributes, such as avoiding a “unit” of negative judgment bias ($8.75), delaying injection frequency by 1 month ($6.60), and increasing services location privacy ($0.37).
The researchers cautioned that findings may not apply to a broader, more ethnically diverse MSM population because most respondents were white and well educated. They listed potential facilitators of LAI-PrEP adoption as injection frequency (every 2 months acceptable, but even less frequent dosing better). In contrast, issues like location of services and PrEP stigma raised little concern. Potential severe side effects emerged as the most important barrier to trying LAI-PrEP, while out-of-pocket costs proved the second biggest worry. The researchers see a need for insurance and “other subsidies” to cover the cost of long-acting PrEP.
1. Beckham SW, Sanchez T, Zlototrzynska M, et al. Preferences for implementing long-acting injectable pre-exposure prophylaxis among cisgender men who have sex with men in the US. IAS 2021, 11th IAS Conference on HIV Science, July 18-21, 2021. Abstract OALC0502.
2. Study summary HPTN 083. July 7, 2020. https://www.hptn.org/research/studies/hptn083
3. Marzinke MA, Grinsztejn B, Fogel JM, et al. Characterization of HIV infection in cisgender men and transgender women who have sex with men receiving injectable cabotegravir for HIV prevention: HPTN 083. J Infect Dis. 2021 Mar 19;jiab152. doi: 10.1093/infdis/jiab152.
4. Ryan M, Bate A, Eastmond CJ, Ludbrook A. Use of discrete choice experiments to elicit preferences. BMJ Quality and Safety. 2001;10:i55-i60. http://dx.doi.org/10.1136/qhc.0100055..