Preferences for on-demand/intermittent/event-driven and long-acting injectable (LAI) HIV pre-exposure prophylaxis (PrEP) among HIV-negative Black gay, bisexual, and other sexual minority men in the United States: A qualitative study.

<h4>Background</h4>Black sexual minority men (SMM) are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is a medication that reduces HIV acquisition. There is a gap in our understanding of the acceptability of and preference for on-demand and long-acting injectable (LA...

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Main Authors: Adedotun Ogunbajo, Alexa Euceda, Raven Ekundayo, Jamil Smith, Temitope Oke, DeMarc Hickson
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2025-01-01
Series:PLoS ONE
Online Access:https://doi.org/10.1371/journal.pone.0323212
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Summary:<h4>Background</h4>Black sexual minority men (SMM) are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is a medication that reduces HIV acquisition. There is a gap in our understanding of the acceptability of and preference for on-demand and long-acting injectable (LAI)-PrEP among PrEP-eligible Black SMM. This study aimed to explore preference for on-demand and LAI-PrEP and reasons for those preferences among HIV-negative Black SMM of different PrEP use profiles (current PrEP users, current non-PrEP users, and PrEP discontinuers).<h4>Methods</h4>Between March 2022 and April 2023, we conducted 17 focus group discussions (FGDs) with a total of 58 HIV-negative (current PrEP users, non-PrEP users, and PrEP discontinuers) Black SMM residing in the Washington D.C. metropolitan area. We explored acceptability and interest in on-demand and LAI-PrEP and anticipated barriers and facilitators to uptake.<h4>Results</h4>Two key themes emerged around interest and preferences for on-demand PrEP and LAI-PrEP: 1) lack of interest in on-demand PrEP, and 2) high acceptability of LAI-PrEP. The reasons for lack of interest in on-demand PrEP were: 1) inability to accurately anticipate and plan for sexual activity in advance, 2) uncertainty about effectiveness of on-demand PrEP, and 3) potential for unnecessary medication use, especially when anticipated sexual activity doesn't occur. Most participants finding LAI-PrEP to be highly acceptable can be attributable to: 1) LAI-PrEP being convenient, and 2) LAI-PrEP being a potential solution to suboptimal adherence to daily oral PrEP due to forgetfulness.<h4>Discussion</h4>While daily oral PrEP is the most utilized PrEP modality, some SMM-who might not be acceptable to oral PrEP-are capable of accurately identifying specific periods and circumstances for HIV infection. It is important that healthcare providers present on-demand PrEP as an option to individuals who fall into these categories. Programs to increase awareness and knowledge of LAI-PrEP among Black SMM and HCP that serve them are needed. Additionally, it is imperative that HCP who provide PrEP services receive proper training on the administration of LAI-PrEP and that there is dedicated staff to help clients navigate the insurance coverage process.
ISSN:1932-6203