Preferences for PrEP access amongst clients presenting for care at novel PrEP delivery models in South Africa: A discrete choice experiment
1
Health Economics and Epidemiology Research Office, Faculty of Health Science, University of the Witwatersrand, Parktown, Johannesburg, South Africa
2
Department of Global Health, University School of Public Health, Boston, MA, United States
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
The uptake of HIV prevention remains suboptimal in South Africa; all individuals who would benefit from prevention are not accessing it 1-2. Understanding the preferences for HIV prevention services, including PrEP, can inform the tailoring of service delivery models to individuals and increase uptake. To support PrEP service delivery optimisation, we explored the preferences of young adults in South Africa using a discrete choice experiment (DCE).
METHODS:
The DCE enrolled young adults (18-35 years) from three provinces (Gauteng, Western Cape, KwaZulu-Natal) who presented for sexual health services at diverse PrEP implementation sites (mobile clinics, fixed clinics, and pharmacies) in South Africa between 09/2024 and 03/2025. The male and female DCE instruments included the following service delivery attributes: locations for initiation and refills, provider type, client cost, PrEP service delivery modality, and confidentiality. Conditional logit models estimated preferences for each attribute.
RESULTS:
580 participants were included (mean age 26). Cost was the strongest driver of PrEP access choice for both females (n=381) and males (n=199), followed by confidentiality and PrEP modality; provider type and refill frequency were not significant in decision-making. Higher cost (>ZAR200, compared to free: OR 0.46, 95% CI [0.39-0.53] females; 0.45 [0.38-0.54] males) and lower confidentiality (compared to higher: 0.76 [0.69-0.81] females; 0.90 [0.82–0.99] males) were not preferred. Within the PrEP modality, the vaginal ring (0.56, [0.49–0.64]) was not favoured by females. Injectable PrEP compared to traditional oral PrEP was favoured by males (1.18, [1.07–1.30]), while females had no clear preferences. Females preferred clinic-based refills over home delivery by healthcare workers (0.81, [0.69–0.95]). Both males and females preferred clinic-based service delivery over non-traditional settings like shops (0.83 [0.70–0.99], males; 0.82 [0.71-0.96], females).
CONCLUSIONS:
Service delivery models should prioritize affordability, PrEP modality choice, location, and privacy to optimize uptake.
The uptake of HIV prevention remains suboptimal in South Africa; all individuals who would benefit from prevention are not accessing it 1-2. Understanding the preferences for HIV prevention services, including PrEP, can inform the tailoring of service delivery models to individuals and increase uptake. To support PrEP service delivery optimisation, we explored the preferences of young adults in South Africa using a discrete choice experiment (DCE).
METHODS:
The DCE enrolled young adults (18-35 years) from three provinces (Gauteng, Western Cape, KwaZulu-Natal) who presented for sexual health services at diverse PrEP implementation sites (mobile clinics, fixed clinics, and pharmacies) in South Africa between 09/2024 and 03/2025. The male and female DCE instruments included the following service delivery attributes: locations for initiation and refills, provider type, client cost, PrEP service delivery modality, and confidentiality. Conditional logit models estimated preferences for each attribute.
RESULTS:
580 participants were included (mean age 26). Cost was the strongest driver of PrEP access choice for both females (n=381) and males (n=199), followed by confidentiality and PrEP modality; provider type and refill frequency were not significant in decision-making. Higher cost (>ZAR200, compared to free: OR 0.46, 95% CI [0.39-0.53] females; 0.45 [0.38-0.54] males) and lower confidentiality (compared to higher: 0.76 [0.69-0.81] females; 0.90 [0.82–0.99] males) were not preferred. Within the PrEP modality, the vaginal ring (0.56, [0.49–0.64]) was not favoured by females. Injectable PrEP compared to traditional oral PrEP was favoured by males (1.18, [1.07–1.30]), while females had no clear preferences. Females preferred clinic-based refills over home delivery by healthcare workers (0.81, [0.69–0.95]). Both males and females preferred clinic-based service delivery over non-traditional settings like shops (0.83 [0.70–0.99], males; 0.82 [0.71-0.96], females).
CONCLUSIONS:
Service delivery models should prioritize affordability, PrEP modality choice, location, and privacy to optimize uptake.
| eISSN: | 2654-1459 |
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