Interest in Long-Acting Injectable PrEP in a Cohort of Men Who have Sex with Men in China

Abstract

Long-acting injectable (LAI) formulations of antiretrovirals (ARVs) as pre-exposure prophylaxis (PrEP) could be an attractive alternative for men who have sex with men (MSM) who are interested in ARV-based biomedical prevention but will not use a daily pill. This study investigated interest in LAI-PrEP in a cohort of MSM in China and characterized how MSM willing to use only injectable PrEP differed from MSM who would use PrEP regardless of modality or not at all. Demographic, behavioral, and risk perception measures were collected and associations investigated. A licensed LAI-PrEP agent would increase the proportion interested in PrEP by 24.5% over oral PrEP alone. Combining interest in oral and injectable PrEP, 78.5% of the sample could be covered if reported interest in PrEP translated into actual uptake. Partnership factors differentiated those who would be willing to use only LAI-PrEP versus any PrEP modality, while higher self-perception of risk was associated with interest in LAI-PrEP versus no PrEP. The addition of a second PrEP modality could yield increased population coverage of PrEP. Social and behavioral research should be undertaken in parallel with clinical development of injectable PrEP agents to identify characteristics of those who are not interested in oral PrEP but would take advantage of ARV-based prevention with the introduction of an injectable product.

Prepared for PrEP: Preferences for HIV pre-exposure prophylaxis among Chinese men who have sex with men from an online national survey

“…Our data suggest that many Chinese MSM prefer injectable PrEP compared to oral PrEP. This finding is consistent with data from China [13] and the US [33]. The preference for injectable PrEP may be due to convenience, decreased frequency of medication taking, and less stigma [33,34].…”

“…We found that interest in using PrEP was associated with using more than one HIV test in a year. MSM who used more than one HIV test in a year may either have riskier behaviors or higher self-perceived risk of acquiring HIV [13,21,30]. This finding also suggests that PrEP services could be integrated with HIV testing services.…”

“…To overcome some of these barriers, alternative formulations like long-acting injectables have shown promise in several clinical trials [11,12]. Without the daily pill burden, long-acting injectable PrEP could potentially simplify HIV prevention services, reduce HIV stigma associated with pill taking, improve HIV prevention services [13]. A national study in the US found that among gay and bisexual men who were willing to use PrEP, more men preferred long-acting injectable PrEP to oral forms [14].…”

“…However, less is known about preferences for injectable PrEP in China and other low-and middleincome countries [15]. Some studies indicated that MSMs in China have low awareness of PrEP (11.2%-33.5%) but high acceptability (54.0%-67.8%) of potentially using PrEP daily [7,13,16].…”

Low willingness to pay for pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in China

“…Along with these PrEP promotion programs, awareness of PrEP (11-58% [5,[8][9][10][11][12]) and willingness to PrEP uptake (64-92%) [13,14] have increasing among MSM globally. The 2017 Chinese National Internet Survey among 4581 MSM showed that 22.4% of them had heard of PrEP and the majority (76%) would like to try PrEP [12].…”