On-Demand and On-Site: Assessing the acceptability of Event-Driven PrEP among cisgender men attending mobile clinics in Cape Town, South Africa
1
Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
2
Desmond Tutu Health Foundation, 3 Woodlands Rd, Woodstock, Cape Town, South Africa
3
Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
4
Department of Global Health, School of Public Health, Boston University, Boston, Massachusettes, United States
Popul. Med. 2026;8(Supplement Supplement 1):A629
ABSTRACT
BACKGROUND:
Event-driven pre-exposure prophylaxis (ED-PrEP) is a non-daily oral HIV prevention regimen taken around sexual episodes. Although the World Health Organization recommends ED-PrEP for cisgender men, it is not yet included in South Africa’s HIV Prevention Guidelines. We applied the Theoretical Framework of Acceptability (TFA) to examine factors influencing ED-PrEP acceptability among cisgender men in Cape Town, South Africa.
METHODS:
We conducted a cross-sectional survey (October–November 2025) among cisgender men aged ≥18 years who self-reported and tested HIV-negative at urban mobile clinics in Cape Town. After standardized ED-PrEP information, participants rated TFA constructs for ED-PrEP use on five-point Likert scales: affective attitude (feeling positive), burden (ease of use), ethicality (values fit), intervention coherence (understanding dosing), opportunity costs (lifestyle adjustment), perceived effectiveness (belief it works), and self-efficacy (confidence in use). Acceptability was defined as “likely/very likely” to use ED-PrEP (binary outcome). We summarized TFA responses descriptively and used simple logistic regression to estimate TFA associations with self-reported acceptability (odds ratios (ORs), 95% confidence intervals (CIs)).
RESULTS:
We enrolled 150 cisgender men (median age 31 years [IQR 26–41]); most identified as Black (93%, 140/150) and heterosexual (89%, 134/150). Nearly all (94%, 141/150) were sexually active in the past three months; almost half reported multiple sexual partners (47%, 66/141). Overall, 87% (130/150) self-reported ED-PrEP acceptability. Most reported favourable perceptions across all TFA constructs (73%–93%), including intervention coherence (93%, 140/150) and perceived effectiveness (92%, 138/150). The largest observed associations were for opportunity costs (OR 41.9, 95% CI 9.1–193.1) and self-efficacy (OR 38.4, 95% CI 11.2–131.5).
CONCLUSIONS:
ED-PrEP had high self-reported acceptability among this population. Positive TFA perceptions suggest readiness for use, with willingness to adjust lifestyle and confidence in use as key drivers of acceptability. These findings provide early implementation evidence to inform ED-PrEP integration into South Africa’s HIV prevention programmes.
Event-driven pre-exposure prophylaxis (ED-PrEP) is a non-daily oral HIV prevention regimen taken around sexual episodes. Although the World Health Organization recommends ED-PrEP for cisgender men, it is not yet included in South Africa’s HIV Prevention Guidelines. We applied the Theoretical Framework of Acceptability (TFA) to examine factors influencing ED-PrEP acceptability among cisgender men in Cape Town, South Africa.
METHODS:
We conducted a cross-sectional survey (October–November 2025) among cisgender men aged ≥18 years who self-reported and tested HIV-negative at urban mobile clinics in Cape Town. After standardized ED-PrEP information, participants rated TFA constructs for ED-PrEP use on five-point Likert scales: affective attitude (feeling positive), burden (ease of use), ethicality (values fit), intervention coherence (understanding dosing), opportunity costs (lifestyle adjustment), perceived effectiveness (belief it works), and self-efficacy (confidence in use). Acceptability was defined as “likely/very likely” to use ED-PrEP (binary outcome). We summarized TFA responses descriptively and used simple logistic regression to estimate TFA associations with self-reported acceptability (odds ratios (ORs), 95% confidence intervals (CIs)).
RESULTS:
We enrolled 150 cisgender men (median age 31 years [IQR 26–41]); most identified as Black (93%, 140/150) and heterosexual (89%, 134/150). Nearly all (94%, 141/150) were sexually active in the past three months; almost half reported multiple sexual partners (47%, 66/141). Overall, 87% (130/150) self-reported ED-PrEP acceptability. Most reported favourable perceptions across all TFA constructs (73%–93%), including intervention coherence (93%, 140/150) and perceived effectiveness (92%, 138/150). The largest observed associations were for opportunity costs (OR 41.9, 95% CI 9.1–193.1) and self-efficacy (OR 38.4, 95% CI 11.2–131.5).
CONCLUSIONS:
ED-PrEP had high self-reported acceptability among this population. Positive TFA perceptions suggest readiness for use, with willingness to adjust lifestyle and confidence in use as key drivers of acceptability. These findings provide early implementation evidence to inform ED-PrEP integration into South Africa’s HIV prevention programmes.
| eISSN: | 2654-1459 |
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