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Shahin Davoudpour, PhD, MA, MA, discusses the challenges associated with access to and persistence with pre-exposure prophylaxis for men who have sex with men.

Gay, bisexual, and other men who have sex with men (GBM) in the US need greater access to pre-exposure prophylaxis (PrEP), researchers report.

“The preferences identified for PrEP care in this diverse GBM sample indicate the need for multiple care and formulation choices including elimination of costs to improve PrEP uptake,” the researchers wrote in AIDS. “Our findings underscore the need for expanding care choices and eliminating costs to improve PrEP uptake for diverse GBM.”

 Two Discrete Choice Experiments

 To identify product or program preferences for PrEP care among GBM in the US, researchers recruited participants in the Together 5,000 study, an internet-based longitudinal study of a geographically diverse national sample of HIV-negative men, trans men, and trans women who have sex with men at elevated HIV risk. Participants had not used PrEP in the past 30 days.

The researchers used two discrete choice experiments (DCEs) to systematically elicit the participants’ preferences. One experiment focused on starting PrEP, and the other focused on continuing PrEP.

The researchers found that 431 (28.5%) participants preferred starting a PrEP conversation and obtaining labs through in-person visits, while 1,083 (71.5%) preferred starting the PrEP conversation by telehealth and self-testing at home. Both groups preferred same-day medication and flexible appointment availability.

For continuing PrEP, 357 (23.6%) of participants preferred low-cost options and on-demand or daily oral PrEP, and they had a strong negative preference for the injectable option, while 1,157 (76.4%) had strong preferences for no-cost and injectable PrEP and a negative preference for the oral option. Cost and formulation were the two most important considerations among all choices.

“The cost of PrEP and associated care remains a key barrier to accessing PrEP in the US,” the researchers wrote. “Our findings suggest that eliminating patient costs may have the largest impact on PrEP uptake relative to other factors examined.”

An Uninvolved Researcher Shares His Expertise

Shahin Davoudpour, PhD MA, MA, a researcher who was not involved in the study, talked with Physician’s Weekly (PW) about the study and its potential impact on increasing PrEP access and use.

PW: Why was this study important to conduct?

 Dr. Davoudpour: This is an important study because, while the perception of PrEP has been well established since its initial introduction as a daily pill with regular HIV testing, the landscape of PrEP care has evolved significantly over the past decade.

PrEP is now available in various formats, yet barriers to its uptake remain. This study brings attention to an often-overlooked issue: It’s not necessarily the attitude toward PrEP that hinders its uptake, but rather the challenges associated with accessing and maintaining access to it. Patients must go to doctors, get tested, obtain a prescription, have it filled, and then remember to take it every day, which can be a significant burden for many.

By highlighting the popularity of virtual visits, at-home HIV testing, injectable PrEP, and the importance of eliminating costs, the study underscores the critical role that patient convenience plays in PrEP delivery. These findings indicate that improving convenience—whether through flexible delivery methods, reducing the burden of frequent visits, or eliminating financial barriers—could significantly increase PrEP uptake and help improve overall HIV prevention efforts.

What are the most important findings?

 This study highlights the critical importance of personalized care options to boost PrEP adoption, which directly impacts how physicians can approach PrEP counseling and delivery.

One of the key findings is the clear divide in preferences regarding care delivery, with some participants favoring in-person services and lab testing and a significant majority preferring virtual care and at-home lab testing. Additionally, there was a strong preference for injectable PrEP, especially when offered at no cost.

For physicians, this underscores the need to assess and understand their patients’ diverse attitudes toward PrEP. By recognizing and addressing individual preferences—whether for virtual care, injectable forms, or cost considerations—physicians can improve PrEP engagement and adherence. These findings encourage a more flexible, patient-centered approach to PrEP delivery, potentially increasing its uptake and adherence.

Research typically shows a certain resistance to change, with many individuals sticking to familiar options rather than embracing new ones. However, the preference for injectable PrEP—and the popularity of telehealth and at-home HIV testing—suggest that people are becoming more open to flexible, less conventional healthcare options, especially related to PrEP.

 What questions remain unanswered for you?

 One unanswered question for me is the role of stigma in PrEP uptake, particularly how virtual care and telehealth might help reduce stigma, whether perceived or anticipated. The study highlights that participants who anticipated stigma from healthcare professionals preferred telehealth and at-home testing, suggesting that these options could ease concerns around disclosure of sexual orientation or behaviors. This finding points to the potential for virtual care to reduce the perceived stigma associated with PrEP.

I would like to see further research that delves deeper into how telehealth and other non-traditional care options can help alleviate stigma and whether these strategies can significantly increase PrEP uptake among individuals who may otherwise avoid it due to fears of judgment and persecution.

I would also be interested in seeing a similar study conducted with former PrEP users to determine if changes in modality, cost, and other factors identified in this study could have influenced their decision to continue adhering to PrEP. Understanding how these factors might impact individuals who have already started and potentially discontinued PrEP could provide valuable insights into strategies for improving long-term adherence and retention in PrEP care.

 Is there anything else clinicians should know?

To me, this study shows that the conversation about PrEP between healthcare professionals and their patients should not be a one-time discussion. As the PrEP landscape evolves—whether through potential changes in financial support, insurance coverage, or new PrEP modalities—it’s important for physicians to keep patients informed about these developments as they happen. Patients’ views and preferences may change in response to these updates, and different settings, such as virtual versus in-person visits, may also influence their reactions.

I encourage physicians to regularly share new information with their patients, ensuring they are aware of the latest available resources and options. This ongoing dialogue can help guide patients toward the best choice for their individual needs.