# P-205. Awareness and Preferences in PrEP Services among Men Who Have Sex With Men in the Philippines: A Discrete Choice Experiment

## TL;DR

This study explores what features of HIV prevention services Filipino men who have sex with men prefer, finding that preferences vary widely and a one-size-fits-all approach is not effective.

## Contribution

The study identifies distinct subgroups of men who have sex with men in the Philippines with differing preferences for PrEP service attributes, informing tailored HIV prevention strategies.

## Key findings

- Filipino men who have sex with men prefer free oral PrEP with minimal side effects and community-led clinics.
- Four distinct subgroups with varying preferences for PrEP attributes were identified through latent class analysis.
- Preferences for cost, formulation, and visit frequency strongly influence PrEP uptake decisions.

## Abstract

Between 2010 and 2023, the Philippines experienced a 550% increase in HIV cases, with men who have sex with men (MSM) disproportionately affected. Although the national rollout of pre-exposure prophylaxis (PrEP) began in 2021, uptake remains minimal. Structural and individual-level barriers, including cost, stigma, and limited service options, continue to hinder PrEP uptake. This study investigates Filipino MSM’s preferences for PrEP service attributes to guide person-centered HIV prevention strategies.

We analyzed the Philippines data from PrEP APPEAL, a multi-country cross-sectional online survey conducted from May to November 2022. The survey included a discrete choice experiment (DCE) evaluating preferences for six PrEP service attributes: type (e.g. oral, long-acting injectable), service location, cost, side effects, visit frequency, and inclusion of additional services. We analyzed preferences using random parameters Logit and latent class models.

Among 2,282 MSM respondents (mean age: 28.8 years, SD: 7.9), 68.9% had heard of PrEP, but only 18.3% were current users (Table 1). Cost, formulation, and side effects most strongly influenced decision-making (Figure 1). Specifically, MSM preferred free oral PrEP accessed through community-led clinics, with minimal side effects and 6-12 month visits. Latent class analysis revealed four distinct subgroups with varying preferences: (1) “Long-Acting Preventive Realists” (27.3%), who prefer long-acting PrEP options without side-effects and with STI testing, (2) “Cost-Conscious Annually-Visiting Pragmatists” (22.1%), who prefer free daily oral PrEP without side effects and with annual visits for refill and STI testing, (3) “Community-based Organization (CBO)-Trusting Lowkey Clinic Visitors” (33.0%), who prefer annual visits at CBOs with low costs, and (4) “Easy-Going PrEP-Hesitants” (17.5), who disliked implants but otherwise no preference on other PrEP types and prefer free and without side-effects (Table 2).

Findings underscore that a one-size-fits-all model is insufficient. National strategies must endorse a variety of community-led PrEP delivery models tailored to as many Filipino MSM with diverse preferences for PrEP products, cost, and visit frequency as possible.

Jason J. Ong, PhD, MMed, MBBS, Australian National Health and Medical Research Council: Grant/Research Support|Gilead Sciences: Grant/Research Support Nittaya Phanuphak, MD, PhD, Aspire Scientific: Medical writing support|Gilead Sciences, Inc.: Grant/Research Support|Gilead Sciences, Inc.: Medical writing support|ViiV Healthcare: Grant/Research Support Benjamin Bavinton, PhD, Gilead Sciences: Grant/Research Support|Gilead Sciences: Honoraria|ViiV Healthcare: Grant/Research Support|ViiV Healthcare: Honoraria