Survey Suggests Cost is an Important Determining Factor for Taking PrEP to Prevent HIV

Cost and adverse events (AEs) are considered the most important issues that men consider before taking pre-exposure prophylaxis (PrEP) medication for HIV, according to new data published in the journal AIDS and Behavior. The studyresults also suggest that patients recommended for PrEP would rather take a long-acting injected form as opposed to a daily pill, or as-needed short course of pills.

“PrEP is very effective at preventing HIV transmission but has relatively low uptake; our results suggest that public health policymakers might be able to boost PrEP uptake by keeping costs low, and if health care practitioners communicate clearly about the potential PrEP side effects, regardless of what type of PrEP they decide to take,” said study co-first author Lorraine T. Dean, ScD, associate professor, Bloomberg School’s Department of Epidemiology, in a press release.

When used correctly, PrEP is 99% effective against HIV infection. The FDA approved PrEP in 2012 as a once-daily pill plus monthly check-ins, with long-acting PrEP injections approved nearly a decade later. But only 25% of people who are recommended for PrEP actually use it, which is reduced by half in Black and Hispanic people, according to the US Centers for Disease Control and Prevention.

Between May 2020 and October 2021, a cohort of 688 gay, bisexual, and other men who have sex with men filled out an online survey in a discrete choice experiment. The survey type is used to uncover real-world preferences and the qualitative strength of these preferences. Investigators studied the link between choice to go on PrEP with other factors, such as cost, AEs, travel time, and uptake method (pill versus an injection).

AEs were considered 1 of 2 important determinates for deciding to take PrEP. In the survey, respondents admitted to wanting a more expensive $200 pill without AEs compared to a free PrEP pill with long-term effects. The most common AEs pf PrEP include nausea, vomiting, and gastrointestinal problems, although only a small percentage of patients reported these symptoms.

Among participants with an income below $75,000 per year or who had previously taken PrEP, the preference for a lower-cost prevention option was also higher. Additionally, participants considered out-of-pocket costs and travel time to follow-up appointments to be important deciding factors.

By 2030, the Ending the HIV Epidemic in the US (EHE) initiative will attempt to increase the number of patients who use PrEP by 50%. The Bloomberg research team is conducting a follow-up study to assess PrEP preferences by demographic groupings.

Injectable PrEP is now available as a monthly injection for 2 months, followed by 1 injection bimonthly. PrEP pills are usually prescribed as a once-daily dose, with an average of 4 check-ups per year.

“Ideally, injectable PrEP needs to be fast, free, and have minimal side effects, and our results suggest that could really be said about all PrEP products,” Dean said in the press release. “I hope our results will encourage non-ACA insurers to keep PrEP at zero cost to those who need it.”

Reference

Johns Hopkins Bloomberg School of Public Health. Study suggests side-effects and costs are biggest concerns for users of HIV pre-exposure prophylaxis. January 31, 2023. Accessed February 1, 2023. https://www.eurekalert.org/news-releases/978239