Preference for HIV Pre-exposure Prophylaxis Access Among Men who Have Sex With Men in China: A Discrete Choice Experiment.

HIV pre-exposure prophylaxis (PrEP) is highly effective but not widely used by men who have sex with men (MSM; 27%) in China.In June 2023, an online cross-sectional survey with a discrete choice experiment (DCE) was distributed to PrEP-eligible MSM in China who were at least 18 years old. The DCE explored attributes of PrEP modality (daily pill, on-demand pill, injections, implants), clinical care model (same-day, 2-visit, telehealth prescription), medication pickup (clinic, community health center, pharmacy, MSM-focused community-based organization, home delivery), enhanced support (self-management, smartphone app, text reminder, anonymous peer support group), and cost.A total of 1013 MSM completed the survey; the average age was 31 years, and a quarter had used PrEP. The most influential attributes were cost (relative importance: 64.6%), followed by PrEP modality (27.7%), medication pickup (4.0%), enhanced support (3.5%), and clinical care model (0.2%). The most preferred ways to access PrEP were no-cost on-demand pill, medication home delivery, self-management, and telehealth. The predicted uptake of on-demand PrEP was higher than other modalities, increasing from 22% with no subsidy to 79% with full subsidy, holding the other 3 attributes constant.Chinese MSM have strong preferences regarding accessing PrEP: Low cost is a critical priority, especially important because medication and clinical care are currently entirely unsubsidized in China. Preferences for on-demand PrEP and home delivery indicate methods that the health care system can utilize to best meet the needs of MSM and factors that should be incorporated into future interventions.

Duke Scholars

Author Daniel Stegmueller Political Science