Strategies to Implement Pre-exposure Prophylaxis with Men Who Have Sex with Men in Ukraine
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Ukrainian men who have sex with men (MSM) remain highly stigmatized group with HIV prevalence as high as 23%. Despite documented effectiveness of pre-exposure prophylaxis (PrEP), PrEP remains unavailable in Ukraine. The aim of this study was to elicit MSM preferences in order to inform program development to facilitate successful delivery of PrEP to Ukrainian MSM. 1184 MSM were recruited through social networking applications to complete a stated preference (choice-based conjoint) survey. Respondents completed 14 choice tasks presenting experimentally-varied combinations of five attributes related to PrEP administration (dosing frequency, dispensing venue, prescription practices, adherence support, and costs). Latent class analysis was used to estimate the relative importance of each attribute and preferences across nine possible PrEP delivery programs. Preferences clustered into five groups. PrEP affordability was the most influential attribute across groups, followed by dosing strategy. Only one group preferred injectable PrEP (n = 216), while the other four groups disliked daily PrEP and strongly preferred the ‘on demand’ option. One group (n = 258) almost exclusively considered cost in their decision making. One group (n = 151) had very low level of interest in PrEP initiation correlated with low self-perceived risk for HIV. The two most at-risk groups (n = 415) were also more sensitive to changes in program delivery. PrEP uptake among MSM is most likely to be successful when PrEP is affordable, its implementation is targeted, provided as “on-demand” with associated education, and when more thorough medical care and related testing is provided to at-risk populations. Its introduction will need affirmation by the Ukrainian government, and guidelines that reflect safety, efficacy, and patient preferences.
KeywordsHIV/AIDS Men who have sex with men Pre-exposure prophylaxis Ukraine Conjoint analysis Patient preferences Implementation science
Financial support for this study was provided in part by the National Institute on Drug Abuse (K24 DA017072, Altice) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (AR060231-05, Fraenkel). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. This study is made possible by the support of the American People through the United States Agency for International Development (USAID). The contents of this study are the sole responsibility of the USAID’s RESPOND Project and the authors, and do not necessarily reflect the views of USAID or the United States Government.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committees (Yale University, Duquesne University) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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