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Perceived access to PrEP as a critical step in engagement: A qualitative analysis and discrete choice experiment among young men who have sex with men

Asiago-Reddy, E.A.; McPeak, J.; Scarpa, R.; Braksmajer, A.; Ruszkowski, N.; McMahon, J.; London, A.S.

Perceived access to PrEP as a critical step in engagement: A qualitative analysis and discrete choice experiment among young men who have sex with men Thumbnail


Authors

E.A. Asiago-Reddy

J. McPeak

A. Braksmajer

N. Ruszkowski

J. McMahon

A.S. London



Abstract

Young Men who have Sex with Men (MSM) continue to face disproportionate HIV risk. Despite its well accepted role in HIV prevention, pre-exposure prophylaxis (PrEP) uptake remains below desired goals. Systemic barriers to PrEP access, including insurance complexity, cost, and wait times to start PrEP may contribute to low PrEP engagement. We conducted in-depth interviews and designed a discrete choice experiment (DCE) to assess preferences for and barriers to PrEP access in the United States. Methods: We conducted in-depth interviews with 18 MSM aged 18–30 years old who were not on PrEP and created a DCE based on the results. For the DCE, a convenience sample of young MSM in the United States who reported recent condomless anal sex was recruited through social media applications. Consenting participants provided sociodemographic information and responded to a series of 10 choice tasks about PrEP access. Preferences were analyzed utilizing marginal willingness-to-pay (mWTP) methods. Results: In-depth interviews revealed preferences for highly effective PrEP and concerns about barriers to access due to insurance coverage and privacy. The online DCE was completed by 236 eligible MSM aged 18–30. The most-preferred PrEP package—with all elements significantly preferred over other options—was insurance covered, could be maintained confidential from parents and employers, was available immediately, and had an online option. Need to take out new insurance or add a supplemental insurance in order to cover PrEP significantly detracted from willingness to pay for a PrEP program. Attributes most associated with willingness to pay for PrEP were PrEP being covered by an insurance the client already has and insurance coverage that was private. Conclusions: Young MSM at high risk for HIV in the United States who are not currently on PrEP showed strong preferences for PrEP options that were covered by insurance and could be kept confidential from parents and employers. Lack of these options may present major barriers to PrEP access among young MSM who are at particularly high risk. Rapid access to PrEP, as well as the option of receiving some care online, may also enhance PrEP uptake.

Citation

Asiago-Reddy, E., McPeak, J., Scarpa, R., Braksmajer, A., Ruszkowski, N., McMahon, J., & London, A. (2022). Perceived access to PrEP as a critical step in engagement: A qualitative analysis and discrete choice experiment among young men who have sex with men. PLoS ONE, 17(1), Article e0258530. https://doi.org/10.1371/journal.pone.0258530

Journal Article Type Article
Acceptance Date Sep 29, 2021
Online Publication Date Jan 26, 2022
Publication Date 2022
Deposit Date Oct 25, 2021
Publicly Available Date Mar 1, 2023
Journal PLOS One
Publisher Public Library of Science
Peer Reviewed Peer Reviewed
Volume 17
Issue 1
Article Number e0258530
DOI https://doi.org/10.1371/journal.pone.0258530
Public URL https://durham-repository.worktribe.com/output/1233486

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Publisher Licence URL
http://creativecommons.org/licenses/by/4.0/

Copyright Statement
© 2022 Asiago-Reddy et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited






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