Attitudes and acceptance of oral and parenteral HIV preexposure prophylaxis among potential user groups: a multinational study

Abstract

Background: The use of antiviral medications by HIV negative people to prevent acquisition of HIV or pre-exposure prophylaxis (PrEP) has shown promising results in recent trials. To understand the potential impact of PrEP for HIV prevention, in addition to efficacy data, we need to understand both the acceptability of PrEP among members of potential user groups and the factors likely to determine uptake.

Methods and findings: Surveys of willingness to use PrEP products were conducted with 1,790 members of potential user groups (FSWs, MSM, IDUs, SDCs and young women) in seven countries: Peru, Ukraine, India, Kenya, Botswana, Uganda and South Africa. Analyses of variance were used to assess levels of acceptance across different user groups and countries. Conjoint analysis was used to examine the attitudes and preferences towards hypothetical and known attributes of PrEP programs and medications. Overall, members of potential user groups were willing to consider taking PrEP (61% reported that they would definitely use PrEP). Current results demonstrate that key user groups in different countries perceived PrEP as giving them new possibilities in their lives and would consider using it as soon as it becomes available. These results were maintained when subjects were reminded of potential side effects, the need to combine condom use with PrEP, and for regular HIV testing. Across populations, route of administration was considered the most important attribute of the presented alternatives.

Conclusions: Despite multiple conceivable barriers, there was a general willingness to adopt PrEP in key populations, which suggests that if efficacious and affordable, it could be a useful tool in HIV prevention. There would be a willingness to experience inconvenience and expense at the levels included in the survey. The results suggest that delivery in a long lasting injection would be a good target in drug development.

Figure 1. Acceptance of PrEP.

SDCs denotes serodiscordant couples, MSM men who have sex with other men, FSWs female sex workers, YW young women and IDUs injection drug users.

Figure 2. Relative importance of key PrEP attributes.

SDCs denotes serodiscordant couples, MSM men who have sex with other men, FSWs female sex workers, YW young women and IDUs injection drug users.

Figure 3. Marginal utilities—relative importance of the levels of PrEP attributes.

SDCs denotes serodiscordant couples, MSM men who have sex with other men, FSWs female sex workers, YW young women and IDUs injection drug users. (4, −4) is an arbitrary interval.