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Willingness to Use Pre-exposure Prophylaxis (PrEP) and Preferences Among Men Who have Sex with Men in Mumbai and Chennai, India: A Discrete Choice Experiment

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Abstract

Pre-exposure prophylaxis (PrEP) programs are planned for key populations in India. We examined PrEP awareness and willingness to use PrEP in order to support products and services for MSM. From December 2016 to March 2017, we conducted a survey and discrete choice experiment (DCE)—a technique to quantify the strength of participants’ trade-off preferences among various product attributes—to assess willingness to use PrEP and related preferences. MSM were recruited from cruising sites and HIV prevention services in Mumbai and Chennai. DCE data were analyzed using mixed logit regression models and estimated marginal willingness-to-pay, the relative value participants’ place on different PrEP attributes. Overall, 76.6% indicated willingness to use PrEP. Efficacy had the greatest effect on choice (high vs. moderate, aOR = 19.9; 95% CI 13.0–30.4), followed by dosing frequency (intermittent vs. daily regimen, aOR = 2.02; 95% CI 1.8–2.2). Participants preferred no (vs. minor) side-effects, subsidized (vs. market) price, and government (vs. private) hospitals. Findings suggest that educational and social marketing interventions should emphasize PrEP’s high efficacy and minimal side effects, and programs should provide government-subsidized PrEP with choices of intermittent or daily dosing delivered by government and private hospitals/clinics in order to optimize PrEP uptake among MSM in India.

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Acknowledgements

We thank the research and project staff of our community partners, Sahodaran (Chennai) and the Humsafar Trust (Mumbai) for successful implementation of this study.

Funding

This research was supported, in part, by grants from the Canadian Institutes of Health Research (MOP-102512; THA-118570; PI: Newman) and the Canada Foundation for Innovation. Dr. Venkatesan Chakrapani was supported by the DBT/Wellcome Trust India Alliance Senior Fellowship (IA/CPHS/16/1/502667). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India

    Venkatesan Chakrapani, Murali Shunmugam & Ruban Nelson

  2. The Humsafar Trust, Mumbai, India

    Venkatesan Chakrapani, Shruta Rawat & Dicky Baruah

  3. Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S1V4, Canada

    Peter A. Newman

  4. VOICES-Thailand Foundation, Chiang Mai, Thailand

    Peter A. Newman & Suchon Tepjan

  5. School of Accounting, Finance and Economics, Waikato Management School, University of Waikato, Hamilton, New Zealand

    Michael Cameron & Riccardo Scarpa

  6. Faculty of Science & Technology, Rajamangala University of Technology Phra Nakhon, Bangkok, Thailand

    Surachet Roungprakhon

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  1. Venkatesan Chakrapani
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  2. Peter A. Newman
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Contributions

PAN, VC, MC and RS contributed to the study conception and design. MS, SR, SR, DB, RN and ST performed material preparation and data collection. VC, MC and RS performed the data analysis. VC drafted the manuscript. PAN critically revised and edited the manuscript in its present form. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Peter A. Newman.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical Approval

This study received ethical approvals from the University of Toronto Research Ethics Board (REB) and the Humsafar Trust Research Ethics Committee.

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Informed consent was obtained from all individual participants included in the study.

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Chakrapani, V., Newman, P.A., Cameron, M. et al. Willingness to Use Pre-exposure Prophylaxis (PrEP) and Preferences Among Men Who have Sex with Men in Mumbai and Chennai, India: A Discrete Choice Experiment. AIDS Behav 25, 3074–3084 (2021). https://doi.org/10.1007/s10461-021-03253-5

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