Alternatives to daily dosing of HIV pre-exposure prophylaxis (PrEP) are continuing to emerge. From October 2019 to March 2020, we conducted an online survey of PrEP-experienced gay and bisexual men in Australia about interest in and preference for four different PrEP modalities: daily dosing, event-driven dosing, long-acting injectable (LAI)-PrEP and subdermal PrEP implants. Using data from 1477 participants, we measured interest and preference of different modalities using multivariate logistic regression. High proportions of participants were interested in LAI-PrEP (59.7%), daily PrEP (52.0%), PrEP implants (45.3%) and event-driven PrEP (42.8%). LAI-PrEP was the most frequently selected preference (30.5%), followed by PrEP implants (26.3%), daily PrEP (21.4%) and event-driven PrEP (21.2%). Higher interest and preference for non-daily PrEP modalities were associated with being concerned about side effects and perceived difficulties with daily adherence. As novel modalities emerge, attitudes to them should be considered in public health messaging to facilitate informed decision-making.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Consent for Publication
Participants signed informed consent regarding publishing their data.
World Health Organization. Consolidated HIV strategic information guidelines: driving impact through programme monitoring and management. Geneva: WHO; 2020.
Beyrer C, Baral SD, van Griensven F, Goodreau SM, Chariyalertsak S, Wirtz AL, et al. Global epidemiology of HIV infection in men who have sex with men. Lancet. 2012;380(9839):367–77.
Holt M, Lee E, Lea T, Bavinton B, Broady T, Mao L, et al. HIV preexposure prophylaxis cascades to assess implementation in Australia: results from repeated, national behavioral surveillance of gay and bisexual men, 2014–2018. J Acquir Immune Defic Syndr. 2020;83(3):e16–22.
Hammoud MA, Vaccher S, Jin F, Bourne A, Maher L, Holt M, et al. HIV pre-exposure prophylaxis (PrEP) uptake among gay and bisexual men in Australia and factors associated with the nonuse of PrEP among eligible men: results from a prospective cohort study. J Acquir Immune Defic Syndr. 2019;81(3):e73–84.
Edeza A, Karina Santamaria E, Valente PK, Gomez A, Ogunbajo A, Biello K. Experienced barriers to adherence to pre-exposure prophylaxis for HIV prevention among MSM: a systematic review and meta-ethnography of qualitative studies. AIDS Care. 2020;33(6):1–9.
Sidebottom D, Ekstrom AM, Stromdahl S. A systematic review of adherence to oral pre-exposure prophylaxis for HIV—how can we improve uptake and adherence? BMC Infect Dis. 2018;18(1):581.
World Health Organization. What’s the 2+1+1? Event-driven oral pre-exposure prophylaxis to prevent HIV for men who have sex with men: update to WHO’s recommendation on oral PrEP. Geneva: World Health Organization; 2019.
Molina JM, Capitant C, Spire B, Pialoux G, Cotte L, Charreau I, et al. On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. N Engl J Med. 2015;373(23):2237–46.
ASHM. The ASHM PrEP Guidelines September 2019 update. ASHM; 2019.
Cornelisse VJ, Lal L, Price B, Ryan KE, Bell C, Owen L, et al. Interest in switching to on-demand HIV pre-exposure prophylaxis (PrEP) among Australian users of daily PrEP: an online survey. Open Forum Infect Dis. 2019;6(7):ofz287.
Pleuhs B, Quinn KG, Walsh JL, Petroll AE, John SA. Health care provider barriers to HIV pre-exposure prophylaxis in the United States: a systematic review. AIDS Patient Care STDS. 2020;34(3):111–23.
Yi S, Tuot S, Mwai GW, Ngin C, Chhim K, Pal K, et al. Awareness and willingness to use HIV pre-exposure prophylaxis among men who have sex with men in low- and middle-income countries: a systematic review and meta-analysis. J Int AIDS Soc. 2017;20(1):21580.
Coelho LE, Torres TS, Veloso VG, Landovitz RJ, Grinsztejn B. Pre-exposure prophylaxis 2.0: new drugs and technologies in the pipeline. Lancet HIV. 2019;6(11):e788–99.
Landovitz RJ, Donnell DJ, Clement M, Hanscom B, Cottle L, Coelho L, et al. HPTN083 interim results: pre‐exposure prophylaxis (PrEP) containing long‐acting injectable cabotegravir (CAB‐LA) is safe and highly effective for cisgender men and transgender women who have sex with men (MSM, TGW). In: International AIDS conference 2020; virtual. International AIDS Society; 2020.
Hall EW, Heneine W, Sanchez T, Sineath RC, Sullivan P. Preexposure prophylaxis modality preferences among men who have sex with men and use social media in the United States. J Med Internet Res. 2016;18(5):e111.
Levy ME, Patrick R, Gamble J, Rawls A, Opoku J, Magnus M, et al. Willingness of community-recruited men who have sex with men in Washington, DC to use long-acting injectable HIV pre-exposure prophylaxis. PLoS ONE. 2017;12(8):e0183521.
Meyers K, Wu Y, Brill A, Sandfort T, Golub SA. To switch or not to switch: Intentions to switch to injectable PrEP among gay and bisexual men with at least twelve months oral PrEP experience. PLoS ONE. 2018;13(7):e0200296.
Parsons JT, Rendina HJ, Whitfield TH, Grov C. Familiarity with and preferences for oral and long-acting injectable HIV pre-exposure prophylaxis (PrEP) in a national sample of gay and bisexual men in the U.S. AIDS Behav. 2016;20(7):1390–9.
Greene GJ, Swann G, Fought AJ, Carballo-Dieguez A, Hope TJ, Kiser PF, et al. Preferences for long-acting pre-exposure prophylaxis (PrEP), daily oral PrEP, or condoms for HIV prevention among U.S. men who have sex with men. AIDS Behav. 2017;21(5):1336–49.
Ellison J, van den Berg JJ, Montgomery MC, Tao J, Pashankar R, Mimiaga MJ, et al. Next-generation HIV pre-exposure prophylaxis preferences among men who have sex with men taking daily oral pre-exposure prophylaxis. AIDS Patient Care STDS. 2019;33(11):482–91.
Vaccher SJ, Gianacas C, Templeton DJ, Poynten IM, Haire BG, Ooi C, et al. Baseline preferences for daily, event-driven, or periodic HIV pre-exposure prophylaxis among gay and bisexual men in the PRELUDE Demonstration Project. Front Public Health. 2017;5:341.
Grulich AE, Guy R, Amin J, Jin F, Selvey C, Holden J, et al. Population-level effectiveness of rapid, targeted, high-coverage roll-out of HIV pre-exposure prophylaxis in men who have sex with men: the EPIC-NSW prospective cohort study. Lancet HIV. 2018;5(11):e629–37.
Zablotska IB, Selvey C, Guy R, Price K, Holden J, Schmidt HM, et al. Expanded HIV pre-exposure prophylaxis (PrEP) implementation in communities in New South Wales, Australia (EPIC-NSW): design of an open label, single arm implementation trial. BMC Public Health. 2018;18(1):210.
Chan C, Broady T, Bavinton BR, Mao L, Bear B, Mackie B, et al. Gay Community Periodic Survey: Sydney 2020. Centre for Social Research in Health, UNSW Sydney; 2020.
Brooks B, Park SH, Guilamo-Ramos V, Schneider JA, Harry-Hernandez S, Mgbako O, et al. Sex tourism and pre-exposure prophylaxis modality preferences among men who have sex with men. J Sex Res. 2019;56(4–5):632–40.
Patel RR, Crane JS, Lopez J, Chan PA, Liu AY, Tooba R, et al. Pre-exposure prophylaxis for HIV prevention preferences among young adult African American men who have sex with men. PLoS ONE. 2018;13(12):e0209484.
Rael CT, Lentz C, Carballo-Dieguez A, Giguere R, Dolezal C, Feller D, et al. Understanding the acceptability of subdermal implants as a possible new HIV prevention method: multi-stage mixed methods study. J Med Internet Res. 2020;22(7):e16904.
Peng P, Su S, Fairley CK, Chu M, Jiang S, Zhuang X, et al. A global estimate of the acceptability of pre-exposure prophylaxis for HIV among men who have sex with men: a systematic review and meta-analysis. AIDS Behav. 2018;22(4):1063–74.
Bauermeister JA, Downs JS, Krakower DS. PrEP product acceptability and dual process decision-making among men who have sex with men. Curr HIV/AIDS Rep. 2020;17(3):161–70.
Tolley EE, Zangeneh SZ, Chau G, Eron J, Grinsztejn B, Humphries H, et al. Acceptability of long-acting injectable cabotegravir (CAB LA) in HIV-uninfected individuals: HPTN 077. AIDS Behav. 2020;24(9):2520–31.
John SA, Whitfield THF, Rendina HJ, Parsons JT, Grov C. Will gay and bisexual men taking oral pre-exposure prophylaxis (PrEP) switch to long-acting injectable PrEP should it become available? AIDS Behav. 2018;22(4):1184–9.
Holt M, Lea T, Bear B, Halliday D, Ellard J, Murphy D, et al. Trends in attitudes to and the use of HIV pre-exposure prophylaxis by Australian gay and bisexual men, 2011–2017: implications for further implementation from a diffusion of innovations perspective. AIDS Behav. 2019;23(7):1939–50.
The authors would like to thank all the participants of the study and the collaborating organisations ACON and the Centre for Social Research in Health (CSRH). The PrEP in NSW Transition Study was supported by Funds from the NSW Ministry of Health.
Conflict of interest
The authors have no conflicts of interest to declare that are relevant to the content of this article.
The questionnaire and methodology for this study was approved by the Human Research Ethics Committee of the University of New South Wales (Ethics Approval Number HC180411).
Informed consent was obtained from all individual participants included in the study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Chan, C., Vaccher, S., Fraser, D. et al. Preferences for Current and Future PrEP Modalities Among PrEP-Experienced Gay and Bisexual Men in Australia. AIDS Behav 26, 88–95 (2022). https://doi.org/10.1007/s10461-021-03344-3