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On-Demand and Long-Acting PrEP
Both Stir Interest in US Survey of MSM
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IDWeek 2022, October 19-23, 2022, Washington, DC
Mark Mascolini
Men who have sex with men (MSM) not currently using daily oral pre-exposure prophylaxis (PrEP) against HIV-but interested in trying it-said they would prefer on-demand (OD) PrEP more often than they favored daily oral PrEP or long-acting (LA) injected PrEP, according to results of an online nationwide US survey [1]. But among MSM currently taking daily oral PrEP, more than half would like to switch dosing, and most of that group ranked LA-PrEP their first choice.
Although highly effective in preventing HIV infection if used correctly, daily oral PrEP has not attracted legions of adherents in the United States. The CDC reported that in 2020 about 25% of an estimated 1.2 million people for whom PrEP is recommended used it [2]. Researchers from the Johns Hopkins Bloomberg School of Public Health and colleagues from other centers speculated that easier-to-use PrEP methods like on-demand PrEP (taking PrEP pills only before and after sex) and every-2-month injectable LA-PrEP could widen uptake of this preventive strategy.
From September 2021 to February 2022, the researchers used ads on social media and MSM hook-up and gay-interest websites and apps to recruit MSM who would take the online survey. Participants had to be 15 or older, cisgender male, and US residents. They had to have oral or anal sex with a man at least once or (for 15- to 17-year-olds) identify themselves as gay or bisexual. Participants could not have a prior HIV diagnosis. The survey asked men their PrEP preferences if they could get PrEP free.
Respondents included 5585 men not currently using daily oral PrEP and 2332 currently using daily PrEP. In the group not now using PrEP, almost exactly half said they would try at least one form of PrEP, and in this willing group, 40.11% said they would try on-demand PrEP, 39.37% would try daily oral PrEP, and 26.45% would try LA-PrEP.
Among the 18.82% of men who claimed they would try any of the three types of PrEP, the largest proportion, 43.86% ranked LA-PrEP as their first choice, 35.39% rated daily oral PrEP their first choice, and 19.31% favored on-demand PrEP most. Only tiny proportions of this PrEP-naive group reported they would try only on-demand PrEP (6.05%), only daily oral PrEP (5.28%), or only LA-PrEP (2.00%).
In the 2332-man group currently taking daily oral PrEP pills, 57.55% said they would try at least one other form of PrEP, while 30.06% said they wanted to stick with daily oral PrEP. Among these current oral PrEP users, 46.4% said they would try LA-PrEP and 31.35% would try on-demand PrEP. Among the 20.2% of men willing to try either of the newer types of PrEP, 68.15% ranked LA-PrEP as their first choice and 31.85% rated on-demand PrEP their top pick.
The research team used multivariable logistic regression adjusted for age, race/ethnicity, insurance status, and ever hearing of PrEP to determine adjusted prevalence ratios (aPR) for men's willingness to try injectable LA-PrEP.
Among MSM not currently using daily pill PrEP, Hispanic men proved more likely than white men to say they would try LA-PrEP (aPR 1.34, 95% CI 1.15 to 1.56). But Hispanic versus white ethnicity did not affect LA-PrEP willingness among current daily PrEP users. Among men not now using PrEP, having some form of insurance other than private lowered chances of interest in LA-PrEP compared with men who had private insurance (aPR 0.77, 95% CI 0.61 to 0.96). But insurance status did not independently affect LA-PrEP willingness among current daily PrEP users.
In the current PrEP-user group, men who had heard of LA-PrEP were more likely to say they would try LA-PrEP than men who had not heard of it (aPR 1.18, 95% CI 1.04 to 1.33). And among men not currently using daily PrEP, having heard of LA-PrEP also favored willingness to try it compared with men who had not heard of it (aPR 1.16, 95% CI 1.01 to 1.32). Age did not affect willingness to try LA-PrEP in these analyses.
The researchers concluded that US MSM show "a substantial interest" in the new PrEP options-on-demand PrEP and injectable LA-PrEP. Current daily PrEP users voiced more interest in LA-PrEP than men not using oral PrEP, who leaned toward on-demand PrEP. The research team suggested their findings "highlight the potential role that newer PrEP options will play in community uptake of PrEP." Of course people who say they will try certain forms of PrEP may not actually try them if the opportunity arises.
References
1. Sanchez T, Beckham SW, Hannah M, et al. Relative patient preferences for starting daily, on-demand, and long-acting injectable HIV pre-exposure prophylaxis among US men who have sex with men, 2021-2022. IDWeek 2022, October 19-23, 2022, Washington, DC. Abstract 2089.
2. CDC, Centers for Disease Control and Prevention. PrEP for HIV Prevention in the U.S. https://www.cdc.gov/nchhstp/newsroom/fact-sheets/hiv/PrEP-for-hiv-prevention-in-the-US-factsheet.html
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