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. 2025 Jun 1;99(2):128-137.
doi: 10.1097/QAI.0000000000003651.

Preferences for Monthly Oral PrEP Over Other PrEP Modalities Among a National Sample of Gay, Bisexual, and Other Men Who Have Sex With Men in the United States

Ronnie M Gravett  1 , Dustin M Long  2 , Katie B Biello  3   4   5   6 , Kenneth H Mayer  6   7 , Douglas S Krakower  6   7 , Jonathan Hill-Rorie  6 , Rebecca A Lillis  8 , Yohance Whiteside  9 , Latesha Elopre  1
Affiliations

Preferences for Monthly Oral PrEP Over Other PrEP Modalities Among a National Sample of Gay, Bisexual, and Other Men Who Have Sex With Men in the United States

Ronnie M Gravett et al. J Acquir Immune Defic Syndr. .

Abstract

Introduction: Pre-exposure prophylaxis (PrEP) cannot meaningfully affect the HIV epidemic in the United States without improving access to PrEP and reducing PrEP disparities among gay, bisexual, and other men who have sex with men (GBM), especially GBM of color. A patient-centered approach to increase PrEP options will offer better PrEP solutions to GBM. We sought to understand how GBM prefer current and emerging PrEP modalities.

Methods: We conducted a national online survey among adult GBM to determine preferences for current and emerging PrEP modalities (daily, on-demand, and monthly oral, subcutaneous and intramuscular injectable, implantable, and rectal douche) and perceived barriers, based on their lived experiences. We determined PrEP modality preferences and associations using multivariable exploded logit regression model.

Results: In total, 723 GBM completed the survey. The largest proportion preferred monthly oral PrEP (n = 207, 28.6%), and more than half preferred some form of oral PrEP. Race was significantly associated with PrEP modality preference, and Black GBM preferred daily oral PrEP most. Side effects, health care visits, administration route, and frequency influenced PrEP preferences. PrEP and HIV knowledge, and HIV risk were associated with PrEP modality choice. GBM considered out-of-pocket cost and side effects as the significant barriers to PrEP care.

Conclusions: Monthly oral PrEP was most preferred with oral options preferred more than other modalities. Black GBM most preferred daily oral PrEP, which could be because of lack of familiarity with the emerging products. Future PrEP provision must include patient-centered prevention plans that include enhanced education and counseling to promote use of newer agents.

Keywords: HIV; conjoint analysis; men who have sex with men; pre-exposure prophylaxis; social determinants of health.

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Conflict of interest statement

R.M.G. has no conflicts of interest to declare. K.H.M. has received unrestricted research grants from Merck & Co., Inc., Rahway, NJ, ViiV Healthcare, and Gilead Sciences. D.S.K. has conducted research with funds from Gilead Sciences and Merck & Co., Inc., Rahway, NJ to his institution and has received personal funds from Medscape and UpToDate, Inc. to develop medical education content. K.B.B. has received unrestricted research grants from Merck & Co., Inc., Rahway, NJ. R.A.L. has conducted clinical trials at her institution for Abbott, Becton Dickenson, BioFire, Cepheid, Chembio, Cue, Gilead, Hologic, LabCorp, Merck & Co., Inc., Rahway, NJ, QuidelOrtho, Roche, and Visby; has served on a scientific advisory board for Abbott and Roche; and has received personal fees for educational events from Cepheid and Roche. Y.W. is an employee of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, and is a shareholder in Merck & Co., Inc., Rahway, NJ. L.E. has received unrestricted research grants from Merck & Co., Inc., Rahway, NJ.

References

    1. Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2018–2022. HIV Surveill Supplemental Rep. 2024;29.
    1. Centers for Disease Control and Prevention HIV Surveillance Report, 2021. Vol 34; 2023.
    1. Pitasi MA, Beer L, Cha S, et al. Vital signs: HIV infection, diagnosis, treatment, and prevention among gay, bisexual, and other men who have sex with men—United States, 2010-2019. MMWR Morb Mortal Wkly Rep. 2021;70:1669–1675.
    1. Kanny D, Jeffries WL IV, Chapin-Bardales J, et al. Racial/ethnic disparities in HIV preexposure prophylaxis among men who have sex with men - 23 urban areas, 2017. MMWR Morb Mortal Wkly Rep. 2019;68:801–806.
    1. Keen P, Bavinton BR. Could disparities in PrEP uptake limit the public health benefit?. Lancet Public Health. 2020;5:e467–e468.

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