Preferences for pre-exposure prophylaxis among U.S. military men who have sex with men: results of an adaptive choice based conjoint analysis study

José I. Gutierrez; Alex Dubov; Frederick L. Altice; David Vlahov

doi:10.1186/s40779-021-00323-6

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Preferences for pre-exposure prophylaxis among U.S. military men who have sex with men: results of an adaptive choice based conjoint analysis study

RESEARCH | Updated：2023-02-28

- Preferences for pre-exposure prophylaxis among U.S. military men who have sex with men: results of an adaptive choice based conjoint analysis study
- Military Medical Research Vol. 9, Issue 2, Pages: 141-151(2022)
- Affiliations：
  
  1.Yale School of Nursing, 400 West Campus Drive, Orange, CT 06477, USA
  2.Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 3333 California St, San Francisco, CA 94118, USA
  3.Loma Linda University, Griggs Hall 11065, Loma Linda, CA 92350, USA
  4.Yale School of Medicine, Section of Infectious Diseases, 135 College Street, Suite 323, New Haven, CT 06510, USA
  5.Department of Epidemiology-Microbial Diseases, Yale School of Public Health, 60 College St, New Haven, CT 06510, USA
- Author bio：
  
  * jose.gutierrez@aya.yale.edu
- Funds：
- DOI：10.1186/s40779-021-00323-6
  CLC：
- Published：2022-04
- Accepted：
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Gutierrez et al.: Preferences for pre-exposure prophylaxis among U.S. military men who have sex with men: results of an adaptive choice based conjoint analysis study. Mil Med Res, 2021, 8: 32.
DOI：

Gutierrez et al.: Preferences for pre-exposure prophylaxis among U.S. military men who have sex with men: results of an adaptive choice based conjoint analysis study. Mil Med Res, 2021, 8: 32. DOI： 10.1186/s40779-021-00323-6.

摘要

Abstract

Background:

Pre-exposure prophylaxis (PrEP) prevents human immunodeficiency virus (HIV) infection

but its use remains low among U.S. military men who have sex with men (MSM)

likely due to mis-matching with personal preferences. We conducted a study to characterize preferences to PrEP measures within this population.

Methods:

HIV-negative military MSM were recruited through a closed

Lesbian

Gay

Bisexual

and Transgendered (LGBT) military social media group. The survey was anonymous

and consisted of five experimentally varied attributes in service delivery: dosing method

provider type

visit location

lab work evaluation location

and dispensing venue. Relative importance and part-worth utility scores were generated using hierarchical bayes (HB) estimation

and the randomized first choice model was used to examine participation interest across eight possible PrEP program scenarios.

Results:

A total of 429 participants completed the survey. Among the eight scenarios with varying attributes

the most preferred scenario featured a daily tablet

PrEP injection or implant

along with a military provider

smartphone/telehealth visit

and on-base locations for lab evaluation and medication pick-up. The results also emphasized the importance for providers to be familiar with PrEP prescription knowledge

and to provide interactions sensitive to sexual identity and mental health.

Conclusions:

A PrEP program consisting of daily tablet is preferred in military healthcare settings is preferred. Long-acting implants and injections are also desired.

关键词

Keywords

references

Armed Forces Health Surveillance B . Update: Routine screening for antibodies to human immunodeficiency virus, civilian applicants for U.S. military service and U.S. Armed forces, active and reserve components, January 2013-June 2018 . MSMR . 2018 ; 25 ( 9 ): 2 - 8 .

Blaylock JM , Hakre S , Okulicz JF , Garges E , Wilson K , Lay J , et al . HIV preexposure prophylaxis in the U.S. military services - 2014-2016 . MMWR Morb Mortal Wkly Rep . 2018 ; 67 ( 20 ): 569 - 74 . https://doi.org/10.15585/mmwr.mm6720a1 https://doi.org/10.15585/mmwr.mm6720a1 .

Hakre S , Scoville SL , Pacha LA , Peel SA , Kim JH , Michael NL , et al . Brief report: sexual risk behaviors of HIV seroconverters in the US army, 2012-2014 . J Acquir Immune Defic Syndr . 2015 ; 70 ( 4 ): 456 - 61 . https://doi.org/10.1097/QAI.0000000000000778 https://doi.org/10.1097/QAI.0000000000000778 .

Patterson SB , Rivera D , Sunil TS , Okulicz JF . Evaluation of extragenital screening for gonorrhea and chlamydia in HIV-infected active duty air force members . MSMR . 2014 ; 21 ( 11 ): 7 - 9 .

Hakre S , Mydlarz DG , Dawson P , Danaher PJ , Gould PL , Witkop CT , et al . Epidemiology of HIV among US air force military personnel, 1996-2011 . PLoS One . 2015 ; 10 ( 5 ): e0126700 . https://doi.org/10.1371/journal.pone.0126700 https://doi.org/10.1371/journal.pone.0126700 .

Blaylock JM , Hakre S , Decker CF , Wilson B , Bianchi E , Michael N , et al . HIV PrEP in the military: Experience at a tertiary care military medical center . Mil Med . 2018 ; 183 ( suppl_1 ): 445 - 9 .

Thigpen MC , Kebaabetswe PM , Paxton LA , Smith DK , Rose CE , Segolodi TM , et al . Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana . N Engl J Med . 2012 ; 367 ( 5 ): 423 - 34 . https://doi.org/10.1056/NEJMoa1110711 https://doi.org/10.1056/NEJMoa1110711 .

Grant RM , Lama JR , Anderson PL , Mcmahan V , Liu AY , Vargas L , et al . Preexposure chemoprophylaxis for HIV prevention in men who have sex with men . N Engl J Med . 2010 ; 363 ( 27 ): 2587 - 99 . https://doi.org/10.1056/NEJMoa1011205 https://doi.org/10.1056/NEJMoa1011205 .

Choopanya K , Martin M , Suntharasamai P , Sangkum U , Mock PA , Leethochawalit M , et al . Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir study): a randomised, double-blind, placebo-controlled phase 3 trial . Lancet . 2013 ; 381 ( 9883 ): 2083 - 90 . https://doi.org/10.1016/S0140-6736(13)61127-7 https://doi.org/10.1016/S0140-6736(13)61127-7 .

Baeten JM , Donnell D , Ndase P , Mugo NR , Campbell JD , Wangisi J , et al . Antiretroviral prophylaxis for HIV prevention in heterosexual men and women . N Engl J Med . 2012 ; 367 ( 5 ): 399 - 410 . https://doi.org/10.1056/NEJMoa1108524 https://doi.org/10.1056/NEJMoa1108524 .

Lykins WR , Luecke E , Johengen D , Van Der Straten A , Desai TA . Long acting systemic HIV pre-exposure prophylaxis: an examination of the field . Drug Deliv Transl Res . 2017 ; 7 ( 6 ): 805 - 16 . https://doi.org/10.1007/s13346-017-0391-6 https://doi.org/10.1007/s13346-017-0391-6 .

Molina JM , Charreau I , Spire B , Cotte L , Chas J , Capitant C , et al . Efficacy, safety, and effect on sexual behaviour of on-demand pre-exposure prophylaxis for HIV in men who have sex with men: an observational cohort study . Lancet HIV . 2017 ; 4 ( 9 ): e402 - e10 . https://doi.org/10.1016/S2352-3018(17)30089-9 https://doi.org/10.1016/S2352-3018(17)30089-9 .

Antoni G , Tremblay C , Delaugerre C , Charreau I , Cua E , Rojas Castro D , et al . On-demand pre-exposure prophylaxis with tenofovir disoproxil fumarate plus emtricitabine among men who have sex with men with less frequent sexual intercourse: a post-hoc analysis of the ANRS IPERGAY trial . Lancet HIV . 2020 ; 7 ( 2 ): e113 - e20 . https://doi.org/10.1016/S2352-3018(19)30341-8 https://doi.org/10.1016/S2352-3018(19)30341-8 .

Pines HA , Gorbach PM , Weiss RE , Hess K , Murphy R , Saunders T , et al . Acceptability of potential rectal microbicide delivery systems for HIV prevention: a randomized crossover trial . AIDS Behav . 2013 ; 17 ( 3 ): 1002 - 15 . https://doi.org/10.1007/s10461-012-0358-z https://doi.org/10.1007/s10461-012-0358-z .

Hendrix CW . HIV antiretroviral pre-exposure prophylaxis: Development challenges and pipeline promise . Clin Pharmacol Ther . 2018 ; 104 ( 6 ): 1082 - 97 . https://doi.org/10.1002/cpt.1227 https://doi.org/10.1002/cpt.1227 .

Dubov A , Fraenkel L , Yorick R , Ogunbajo A , Altice FL . Strategies to implement pre-exposure prophylaxis with men who have sex with men in Ukraine . AIDS Behav . 2018 ; 22 ( 4 ): 1100 - 12 . https://doi.org/10.1007/s10461-017-1996-y https://doi.org/10.1007/s10461-017-1996-y .

Dubov A , Ogunbajo A , Altice FL , Fraenkel L . Optimizing access to PrEP based on MSM preferences: results of a discrete choice experiment . AIDS Care . 2019 ; 31 ( 5 ): 545 - 53 . https://doi.org/10.1080/09540121.2018.1557590:1-9 https://doi.org/10.1080/09540121.2018.1557590:1-9 .

Touger R , Wood BR . A review of telehealth innovations for HIV pre-exposure prophylaxis (PrEP) . Curr HIV/AIDS Rep . 2019 ; 16 ( 1 ): 113 - 9 . https://doi.org/10.1007/s11904-019-00430-z https://doi.org/10.1007/s11904-019-00430-z .

Swift JK , Callahan JL . The impact of client treatment preferences on outcome: a meta-analysis . J Clin Psychol . 2009 ; 65 ( 4 ): 368 - 81 . https://doi.org/10.1002/jclp.20553 https://doi.org/10.1002/jclp.20553 .

Adamson SJ , Bland JM , Hay EM , Johnson RE , Jones GT , Kitchener H , et al . Patients' preferences within randomised trials: systematic review and patient level meta-analysis . BMJ . 2008 ; 337 : a1864 .

Graff FS , Morgan TJ , Epstein EE , Mccrady BS , Cook SM , Jensen NK , et al . Engagement and retention in outpatient alcoholism treatment for women . Am J Addict . 2009 ; 18 ( 4 ): 277 - 88 . https://doi.org/10.1080/10550490902925540 https://doi.org/10.1080/10550490902925540 .

Ryan M , Farrar S . Using conjoint analysis to elicit preferences for health care . BMJ . 2000 ; 320 ( 7248 ): 1530 - 3 . https://doi.org/10.1136/bmj.320.7248.1530 https://doi.org/10.1136/bmj.320.7248.1530 .

Phillips KA , Maddala T , Johnson FR . Measuring preferences for health care interventions using conjoint analysis: an application to HIV testing . Health Serv Res . 2002 ; 37 ( 6 ): 1681 - 705 . https://doi.org/10.1111/1475-6773.01115 https://doi.org/10.1111/1475-6773.01115 .

Viney R , Lancsar E , Louviere J . Discrete choice experiments to measure consumer preferences for health and healthcare . Expert Rev Pharmacoecon Outcomes Res . 2002 ; 2 ( 4 ): 319 - 26 . https://doi.org/10.1586/14737167.2.4.319 https://doi.org/10.1586/14737167.2.4.319 .

Lancsar E , Louviere J . Conducting discrete choice experiments to inform healthcare decision making: a user's guide . Pharmacoeconomics . 2008 ; 26 ( 8 ): 661 - 77 . https://doi.org/10.2165/00019053-200826080-00004 https://doi.org/10.2165/00019053-200826080-00004 .

Opuni M , Bishai D , Gray GE , Mcintyre JA , Martinson NA . Preferences for characteristics of antiretroviral therapy provision in Johannesburg, South Africa: results of a conjoint analysis . AIDS Behav . 2010 ; 14 ( 4 ): 807 - 15 . https://doi.org/10.1007/s10461-009-9584-4 https://doi.org/10.1007/s10461-009-9584-4 .

Anderson CW , Smith HR . Stigma and honor: gay, lesbian, and bisexual people in the US military . In: Diamant L , editor . Homosexual issues in the workplace . Washington, DC : Taylor and Francis ; 1993 . p. 65 – 89 .

Biddix JM , Fogel CI , Perry BB . Comfort levels of active duty gay/bisexual male service members in the military healthcare system . Mil Med . 2013 ; 178 ( 12 ): 1335 - 40 . https://doi.org/10.7205/MILMED-D-13-00044 https://doi.org/10.7205/MILMED-D-13-00044 .

Russell TG . An examination of stigma in the military; 2013 .

Lloyd J , Papworth E , Grant L , Beyrer C , Baral S . Systematic review and meta-analysis of HIV prevalence among men in militaries in low income and middle income countries . Sex Transm Infect . 2014 ; 90 ( 5 ): 382 - 7 . https://doi.org/10.1136/sextrans-2013-051463 https://doi.org/10.1136/sextrans-2013-051463 .

Hakre S , Blaylock JM , Dawson P , Beckett C , Garges EC , Michael NL , et al . Knowledge, attitudes, and beliefs about HIV pre-exposure prophylaxis among US air force health care providers . Medicine (Baltimore) . 2016 ; 95 ( 32 ): e4511 . https://doi.org/10.1097/MD.0000000000004511 https://doi.org/10.1097/MD.0000000000004511 .

Galea JT , Kinsler JJ , Salazar X , Lee SJ , Giron M , Sayles JN , et al . Acceptability of pre-exposure prophylaxis as an HIV prevention strategy: barriers and facilitators to pre-exposure prophylaxis uptake among at-risk Peruvian populations . Int J STD AIDS . 2011 ; 22 ( 5 ): 256 - 62 . https://doi.org/10.1258/ijsa.2009.009255 https://doi.org/10.1258/ijsa.2009.009255 .

Eisingerich AB , Wheelock A , Gomez GB , Garnett GP , Dybul MR , Piot PK . Attitudes and acceptance of oral and parenteral HIV preexposure prophylaxis among potential user groups: a multinational study . PLoS One . 2012 ; 7 ( 1 ): e28238 . https://doi.org/10.1371/journal.pone.0028238 https://doi.org/10.1371/journal.pone.0028238 .

Wheelock A , Eisingerich AB , Ananworanich J , Gomez GB , Hallett TB , Dybul MR , et al . Are Thai MSM willing to take PrEP for HIV prevention? An analysis of attitudes, preferences and acceptance . PLoS One . 2013 ; 8 ( 1 ): e54288 . https://doi.org/10.1371/journal.pone.0054288 https://doi.org/10.1371/journal.pone.0054288 .

Shrestha R , Karki P , Altice FL , Dubov O , Fraenkel L , Huedo-Medina T , et al . Measuring acceptability and preferences for implementation of preexposure prophylaxis (PrEP) using conjoint analysis: an application to primary HIV prevention among high risk drug users . AIDS Behav . 2018 ; 22 ( 4 ): 1228 - 38 . https://doi.org/10.1007/s10461-017-1851-1 https://doi.org/10.1007/s10461-017-1851-1 .

Shrestha R , Altice F , Karki P , Copenhaver M . Developing an integrated, brief biobehavioral HIV prevention intervention for high-risk drug users in treatment: the process and outcome of formative research . Front Immunol . 2017 ; 8 : 561 . https://doi.org/10.3389/fimmu.2017.00561 https://doi.org/10.3389/fimmu.2017.00561 .

Toubia O , Hauser J , Garcia R . Probabilistic polyhedral methods for adaptive choice-based conjoint analysis: theory and application . Marketing Sci . 2007 ; 26 ( 5 ): 596 - 610 . https://doi.org/10.1287/mksc.1060.0257 https://doi.org/10.1287/mksc.1060.0257 .

Chapman C , Alford J , Johnson C , Weidemann R , Lahav M . CBC vs . ACBC: comparing results with real product selection . Sawtooth Software Conference Proceedings , Sequim, WA ; 2009 .

Cunningham CE , Deal K , Chen Y . Adaptive choice-based conjoint analysis: a new patient-centered approach to the assessment of health service preferences . Patient . 2010 ; 3 ( 4 ): 257 - 73 . https://doi.org/10.2165/11537870-000000000-00000 https://doi.org/10.2165/11537870-000000000-00000 .

Lowe B , Kroenke K , Grafe K . Detecting and monitoring depression with a two-item questionnaire (PHQ-2) . J Psychosom Res . 2005 ; 58 ( 2 ): 163 - 71 . https://doi.org/10.1016/j.jpsychores.2004.09.006 https://doi.org/10.1016/j.jpsychores.2004.09.006 .

Whooley MA , Avins AL , Miranda J , Browner WS . Case-finding instruments for depression. Two questions are as good as many . J Gen Intern Med . 1997 ; 12 ( 7 ): 439 - 45 . https://doi.org/10.1046/j.1525-1497.1997.00076.x https://doi.org/10.1046/j.1525-1497.1997.00076.x .

Wilton J , Kain T , Fowler S , Hart TA , Grennan T , Maxwell J , et al . Use of an HIV-risk screening tool to identify optimal candidates for PrEP scale-up among men who have sex with men in Toronto, Canada: disconnect between objective and subjective HIV risk . J Int AIDS Soc . 2016 ; 19 ( 1 ): 20777 . https://doi.org/10.7448/IAS.19.1.20777 https://doi.org/10.7448/IAS.19.1.20777 .

Software S . Lighthouse studio v9.0 (formerly SSIWeb) . Sawtooth Software : Orem, UT ; 2016 .

Software S . Hosting security information . 2018 . https://www.sawtoothsoftwa re.com/88-services/hosting/1457-hosting-security-information https://www.sawtoothsoftwa re.com/88-services/hosting/1457-hosting-security-information .

Orme B . Consistency cutoffs to identify "bad" respondents in CBC, ACBC, and MaxDiff. Sawtooth Software Research Paper Series ; 2019 .

Lenk P , Desarbo W , Green P , Young M . Hierarchical bayes conjoint analysis: recovery of partworth heterogeneity from reduced experimental designs . Marketing Sci . 1996 ; 15 ( 2 ): 173 - 91 . https://doi.org/10.1287/mksc.15.2.173 https://doi.org/10.1287/mksc.15.2.173 .

Rao V . Applied conjoint analysis . Germany : Springer-Verlag Berlin Heidelberg ; 2013 .

Herrmann A , Gustafsson A , Huber F . Conjoint measurement: methods and applications . Germany : Springer-Verlag Berlin Heidelberg ; 2007 .

Orme B . Getting started with conjoint analysis: Strategies for product design and pricing research . 2nd ed . Madison : Research Publishers LLC ; 2010 .

Millar BM , Starks TJ , Grov C , Parsons JT . Sexual risk-taking in HIV-negative gay and bisexual men increases with depression: results from a U.S. National Study . AIDS Behav . 2017 ; 21 ( 6 ): 1665 - 75 . https://doi.org/10.1007/s10461-016-1507-6 https://doi.org/10.1007/s10461-016-1507-6 .

Fendrich M , Avci O , Johnson TP , Mackesy-Amiti ME . Depression, substance use and HIV risk in a probability sample of men who have sex with men . Addict Behav . 2013 ; 38 ( 3 ): 1715 - 8 . https://doi.org/10.1016/j.addbeh.2012.09.005 https://doi.org/10.1016/j.addbeh.2012.09.005 .

Parsons JT , Grov C , Golub SA . Sexual compulsivity, co-occurring psychosocial health problems, and HIV risk among gay and bisexual men: further evidence of a syndemic . Am J Public Health . 2012 ; 102 ( 1 ): 156 - 62 . https://doi.org/10.2105/AJPH.2011.300284 https://doi.org/10.2105/AJPH.2011.300284 .

HIV Prevention Trials Network . HPTN 083, Long-acting injectable cabotegravir is highly effective for the prevention of HIV infection in cisgender men and transgender women who have sex with men . https://www.hptn.org/news-and-events/press-releases/long-acting-injectable-cabotegravirhighly-effective-prevention-hiv https://www.hptn.org/news-and-events/press-releases/long-acting-injectable-cabotegravirhighly-effective-prevention-hiv . Accessed 3 May 2021 .

World Health Organization . Trial results reveal that long-acting injectable cabotegravir as PrEP is highly effective in preventing HIV acquisition in women . https://www.who.int/news/item/09-11-2020-trial-results-reveal-that-long-acting-injectable-cabotegravir-asprep-is-highly-effective-in-preventing-hiv-acquisition-in-women https://www.who.int/news/item/09-11-2020-trial-results-reveal-that-long-acting-injectable-cabotegravir-asprep-is-highly-effective-in-preventing-hiv-acquisition-in-women . Accessed November 9, 2020 .

2019 IAS . First-in-human trial of MK-8591-eluting implants demonstrates concentrations suitable for HIV prophylaxis for at least one year . International AIDS Society . http://programme.ias2019.org/Abstract/Abstract/4843 http://programme.ias2019.org/Abstract/Abstract/4843 . 2019 .

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 . https://doi.org/10.1007/s10461-016-1565-9 https://doi.org/10.1007/s10461-016-1565-9 .

Gleason JL , Beck KH . Examining associations between relocation, continuity of care, and patient satisfaction in military spouses . Mil Med . 2017 ; 182 ( 5–6 ): e1657 - 64 . https://doi.org/10.7205/MILMED-D-16-00191 https://doi.org/10.7205/MILMED-D-16-00191 .

Brown RA , Marshall GN , Breslau J , Farris C , Osilla KC , Pincus HA , et al . Access to behavioral health care for geographically remote service members and dependents in the U.S . Rand Health Q . 2015 ; 5 ( 1 ): 21 .

Blumenthal J , Jain S , Krakower D , Sun X , Young J , Mayer K , et al . Knowledge is power! Increased provider knowledge scores regarding pre-exposure prophylaxis (PrEP) are associated with higher rates of PrEP prescription and future intent to prescribe PrEP . AIDS Behav . 2015 ; 19 ( 5 ): 802 - 10 . https://doi.org/10.1007/s10461-015-0996-z https://doi.org/10.1007/s10461-015-0996-z .

Hernandez-Romieu AC , Sullivan PS , Sanchez TH , Kelley CF , Peterson JL , Del Rio C , et al . The comparability of men who have sex with men recruited from venue-time-space sampling and facebook: a cohort study . JMIR Res Protoc . 2014 ; 3 ( 3 ): e37 . https://doi.org/10.2196/resprot.3342 https://doi.org/10.2196/resprot.3342 .

Grov C , Westmoreland D , Rendina HJ , Nash D . Seeing is believing? Unique capabilities of internet-only studies as a tool for implementation research on HIV prevention for men who have sex with men: A review of studies and methodological considerations . J Acquir Immune Defic Syndr . 2019 ; 82 Suppl 3 ( Suppl 3 ): S253 - 60 .

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