Preferences for PrEP program attributes among Black women across the Southern United States: A discrete choice experiment

Background: HIV disproportionately affects cisgender Black women (CBW), yet fewer than 2% of eligible CBW use pre-exposure prophylaxis (PrEP); an effective biomedical HIV prevention method. To improve PrEP uptake, this study identified CBW’s preferences for key features of PrEP delivery programs using a discrete choice experiment (DCE). Methods: CBW were recruited, screened online, and completed a one-time DCE survey. Participants completed 14 choice tasks involving 6 PrEP program attributes: 1) administration method, 2) access location, 3) healthcare integration, 4) provider demographics, 5) payment options, 6) support services. Hierarchical Bayes models estimated attribute importance; latent class analysis was used to group participants by similar preferences. Results: Among 390 participants, administration method was the top-ranked attribute (48%), followed by provider demographics (13.2%), and access location (12%). Preferences clustered into five groups. Group 1 (n=82), younger women with high educational attainment, preferred telehealth initiated bi-monthly injectable PrEP. Group 2 (n=82), older women with lower HIV vulnerability, favored oral and injectable PrEP prescribed by a physician during women’s health visits. Group 3 (n=108) had the highest HIV vulnerability, showed strong interest in PrEP, preferred the vaginal ring accessed through pharmacies or telehealth. Group 4 (n=59) had the lowest access to healthcare, preferred injectable PrEP in clinical settings with income-based cost adjustments. Group 5 (n=59), one of the youngest and economically advantaged, favored the vaginal ring from a pharmacy. Conclusion: Findings indicate administration method, provider type, and access location mattered most to CBW for PrEP programming, indicating the need to use multiprong approaches to bolster PrEP uptake.