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Abstract
Men who have sex with men (MSM) in Malaysia are disproportionately affected by HIV. As pre-exposure prophylaxis (PrEP) is being introduced, we assessed population-based PrEP delivery preferences among MSM in Malaysia. We conducted a discrete choice experiment through an online survey among 718 MSM. The survey included 14 choice tasks presenting experimentally varied combinations of five attributes related to PrEP delivery (i.e., cost, dosing strategy, clinician interaction strategy, dispensing venue, and burden of visits to start PrEP). We used latent class analysis and Hierarchical Bayesian modeling to generate the relative importance of each attribute and preference across six possible PrEP delivery programs. PrEP dosing, followed by cost, was the most important attribute. The participants were clustered into five preference groups. Two groups (n = 290) most commonly preferred on-demand, while the other three preferred injectable PrEP. One group (n = 188) almost exclusively considered cost in their decision-making, and the smallest group (n = 86) was substantially less interested in PrEP for reasons unrelated to access. In simulated scenarios, PrEP initiation rates varied by the type of program available to 55·0% of MSM. Successful PrEP uptake among Malaysian MSM requires expanding beyond daily oral PrEP to on-demand and long-acting injectable PrEP, especially at affordable cost.
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1 Loma Linda University, School of Behavioral Health, Loma Linda, USA (GRID:grid.43582.38) (ISNI:0000 0000 9852 649X)
2 Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, New Haven, USA (GRID:grid.47100.32) (ISNI:0000000419368710); University of Malaya, Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, Kuala Lumpur, Malaysia (GRID:grid.10347.31) (ISNI:0000 0001 2308 5949)
3 University of California, San Francisco, Department of Family Health Care Nursing, School of Nursing, San Francisco, USA (GRID:grid.266102.1) (ISNI:0000 0001 2297 6811)
4 University of Malaya, Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, Kuala Lumpur, Malaysia (GRID:grid.10347.31) (ISNI:0000 0001 2308 5949); University of Malaya, Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, Kuala Lumpur, Malaysia (GRID:grid.10347.31) (ISNI:0000 0001 2308 5949)
5 Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, New Haven, USA (GRID:grid.47100.32) (ISNI:0000000419368710); University of California, San Francisco, Department of Family Health Care Nursing, School of Nursing, San Francisco, USA (GRID:grid.266102.1) (ISNI:0000 0001 2297 6811); University of Malaya, Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, Kuala Lumpur, Malaysia (GRID:grid.10347.31) (ISNI:0000 0001 2308 5949)
6 University of Connecticut, Department of Allied Health Sciences, Storrs, USA (GRID:grid.63054.34) (ISNI:0000 0001 0860 4915)
7 University of Malaya, Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, Kuala Lumpur, Malaysia (GRID:grid.10347.31) (ISNI:0000 0001 2308 5949); University of California, San Francisco, Department of Family Health Care Nursing, School of Nursing, San Francisco, USA (GRID:grid.266102.1) (ISNI:0000 0001 2297 6811); University of Connecticut, Department of Allied Health Sciences, Storrs, USA (GRID:grid.63054.34) (ISNI:0000 0001 0860 4915)