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Measuring Acceptability and Preferences for Implementation of Pre-Exposure Prophylaxis (PrEP) Using Conjoint Analysis: An Application to Primary HIV Prevention Among High Risk Drug Users

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Abstract

Although people who use drugs (PWUD) are one of the key risk populations who could benefit from the use of pre-exposure prophylaxis (PrEP), to date, little attention has been given to incorporating PrEP into HIV prevention approaches targeting this underserved group. This study investigated the acceptability of PrEP based on a number of known PrEP attributes among high-risk PWUD in a drug treatment setting. A total of 400 HIV-negative PWUD, who reported drug- and/or sex-related risk behaviors were recruited from a methadone clinic to complete a stated preference (full-profile conjoint) survey. Participants ranked the eight hypothetical PrEP program scenarios with varied combinations of six attributes related to PrEP (cost, dosing, efficacy, side-effects, treatment setting, and frequency of HIV testing). SPSS conjoint procedure was used to estimate the relative importance of each attribute and preferences across eight possible PrEP delivery programs. PrEP acceptability ranged from 30.6 to 86.3% with a mean acceptability of 56.2% across the eight hypothetical PrEP program scenarios. The PrEP program scenario with the highest acceptability had the following attribute levels: insurance covered, daily dosing, 95% effective, no side-effects, treatment at HIV clinic, and HIV testing needed every 6 months. The cost associated with PrEP was the most important attribute (relative importance score: RIS = 38.8), followed by efficacy (RIS = 20.5) and side effects (RIS = 11.9); other attributes had no significant effect. Our findings reported a high acceptability of PrEP in response to different PrEP program scenarios with different attribute profiles. As the result of having this information, researchers and policymakers will be better equipped for evidence informed targeting and dissemination efforts to optimize PrEP uptake among this underserved population.

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Source of Funding

This work was supported by grants from the National Institute on Drug Abuse for research (R01 DA025943 to FLA) and for career development (K24 DA017072 to FLA; K02 DA033139 to MMC, K24 AR060231 to LF).

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Authors and Affiliations

  1. Department of Community Medicine & Health Care, University of Connecticut Health Center, 263 Farmington Avenue, MC 6325, Farmington, CT, 06030-6325, USA

    Roman Shrestha

  2. Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA

    Roman Shrestha, Pramila Karki, Frederick L. Altice, Tania Huedo-Medina & Michael Copenhaver

  3. Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA

    Pramila Karki, Tania Huedo-Medina & Michael Copenhaver

  4. Department of Internal Medicine, AIDS Program, Yale University School of Medicine, New Haven, CT, USA

    Frederick L. Altice

  5. School of Public Health, Loma Linda University, Loma Linda, CA, USA

    Oleksandr Dubov

  6. Department of Internal Medicine, Section of Rheumatology, School of Medicine, Yale University, New Haven, CT, USA

    Liana Fraenkel

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  1. Roman Shrestha
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Correspondence to Roman Shrestha.

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The authors have no conflicts of interest to disclose.

Ethical Approval

The study protocol was approved by the Investigational Review Board (IRB) at the University of Connecticut and received board approval from APT Foundation Inc. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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

Appendix

Appendix

Brief description of pre-exposure prophylaxis (PrEP) provided to the participants.

“There is a new way to prevent HIV infection for people who may be exposed to the virus. It is called Pre-Exposure Prophylaxis or PrEP. It involves an HIV-negative person taking a pill daily, on an ongoing basis (starting before an exposure and continuing after for as long as the person is at risk) to reduce their risk of HIV infection. Research suggests that PrEP is generally safe and is highly effective (over 90%) in preventing HIV infection if taken every day. It is much less effective if not taken every day and does not protect against other sexually transmitted infections. Taking PrEP would require a visit to a doctor every 3 months in order to be tested for HIV, STIs and side effects.”

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Shrestha, R., Karki, P., Altice, F.L. et al. Measuring Acceptability and Preferences for Implementation of Pre-Exposure Prophylaxis (PrEP) Using Conjoint Analysis: An Application to Primary HIV Prevention Among High Risk Drug Users. AIDS Behav 22, 1228–1238 (2018). https://doi.org/10.1007/s10461-017-1851-1

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