Awareness of and Hypothetical Willingness to Use Long-Acting Injectable Cabotegravir and Associated Factors Among Oral Pre-Exposure Prophylaxis Users Who Obtained the Medicine Online in China: Web-Based Cross-Sectional Study

Background: Oral pre-exposure prophylaxis (PrEP) is highly effective for HIV prevention, but its real-world impact depends on sustained adherence. Long-acting injectable cabotegravir (CAB-LA) may reduce the burden of daily or event-driven pill use. In China, many oral PrEP users obtain medication online, but little is known about their prior CAB-LA awareness or willingness to consider it. Objective: This study assessed prior CAB-LA awareness, hypothetical willingness to use CAB-LA, reported barriers and facilitators, and associated factors among oral PrEP users in China obtaining PrEP online. Methods: This cross-sectional study analyzed baseline data from the Real-world E-consumer Cohort of Oral PrEP (RECOPE), a prospective cohort in China. Participants completed a self-administered web-based questionnaire assessing prior CAB-LA awareness, hypothetical willingness after standardized CAB-LA information, sociodemographic characteristics, recent sexual behaviors and sexually transmitted infection (STI) diagnosis, and oral PrEP-related characteristics. Modified Poisson regression with robust SEs estimated prevalence ratios (PRs) and adjusted prevalence ratios (aPRs) with 95% CIs. Primary regression analyses were restricted to sexually active participants. Results: Among 621 oral PrEP users, the mean age was 29.9 (SD 6.4) years; all were assigned male sex at birth, and 608 (97.9%) identified as men. Overall, 216 of 621 (34.8%, 95% CI 31.1%-38.6%) participants reported prior CAB-LA awareness. After receiving standardized information, 428 of 621 (68.9%, 95% CI 65.2%-72.4%) participants expressed hypothetical willingness to use CAB-LA if it became available in China. Convenience was the most frequently reported facilitator among willing participants (395/428, 92.3%), whereas high cost was the most frequently reported barrier among those who did not express willingness (123/193, 63.7%). In adjusted analyses, event-driven PrEP users had a lower prevalence of prior CAB-LA awareness than daily PrEP users (aPR 0.66, 95% CI 0.50-0.86), whereas participants who had switched oral PrEP regimens in the past 3 months had higher prior awareness (aPR 1.34, 95% CI 1.07-1.68). Hypothetical willingness was more prevalent among participants reporting an STI diagnosis in the past 3 months (aPR 1.22, 95% CI 1.08-1.39) and chemsex (aPR 1.13, 95% CI 1.01-1.26), whereas higher PrEP-related stigma was associated with slightly lower willingness (aPR 0.99 per 1-point increase, 95% CI 0.98-0.99). Conclusions: Among oral PrEP users in China obtaining PrEP online, prior CAB-LA awareness was limited, whereas hypothetical willingness was common after standardized information was provided. Prior awareness differed by oral PrEP regimen and recent regimen switching, whereas willingness was associated with recent STI diagnosis, chemsex, and PrEP-related stigma. Convenience was a major appeal, while cost remained an important barrier. These findings support improving access to balanced PrEP information and addressing practical barriers as long-acting PrEP becomes more widely available.