Personalized approach may improve PrEP awareness, willingness in MSM, transgenders

A recent study in the Philippines has identified key demographic and behavioural patterns among Filipino men who have sex with men (MSM) and transgender individuals (TGIs) regarding their awareness of pre-exposure prophylaxis (PrEP) and modality preferences.

The analysis revealed three distinct subgroups, namely the unaware and reluctant, the informed condom users, and the enthusiastic adopters, “all with differences in awareness, preferences, and risk behaviours,” said lead author Rodenie Arnaiz Olete, MSc, RN, Sustained Health Initiatives of the Philippines, Mandaluyong City, Philippines.

Overall, 1,662 respondents (mean age 29.2 years) from the 2022 multinational cross-sectional PrEP-APPEAL dataset were included in the analysis. Of these, 1,323 (79.6 percent) were cisgender men, and 88 (5.3 percent) self-identified as TGIs (men and women). In addition, 297 (17.9 percent) were PrEP-experienced, and 297 (14.0 percent) were currently taking PrEP.

In the latent class analysis (LCA), three subgroups of Filipino MSM/TGIs emerged: unaware and reluctant (n=154, 9.3 percent), informed condom users (n=1,282, 77.1 percent), and enthusiastic adopters (n=226, 13.6 percent). [IAS 2025, abstract OAC0405]

The unaware and reluctant subgroup had the lowest PrEP awareness, lowest willingness to pay, lowest willingness to adopt any PrEP options, and lowest number of sex partners. The informed condom users had higher PrEP awareness, moderate willingness to daily and monthly oral PrEP but low willingness to long-acting injectable cabotegravir (CAB-LA), high condom use, and higher number of sex partners.

Moreover, enthusiastic adopters had high PrEP awareness, substantial willingness to adopt all PrEP options, and the highest number of sex partners. They were also more likely to have previously used PrEP (p<0.001), while the informed condom users were more likely to reside in urban areas (p=0.015).

Public emergency

“Person-centred strategies tailored to each group can improve PrEP uptake, expand access to newer modalities, and reduce gaps in HIV prevention in the Philippines,” Olete said.

For context, the Department of Health in the Philippines has recently declared HIV as a national public health emergency. Despite efforts, a sharp and persistent rise in new infections persists, with an average of 57 new cases daily.

“This … emphasizes the urgency [to maximize] all HIV prevention tools, most especially PrEP,” Olete said. “To address the gaps, we need to understand the awareness, willingness, and perception towards PrEP in the Philippines.”

For the unaware and reluctant, Olete suggested highlighting the availability of free oral PrEP and educating them on all PrEP options. For the informed condom users, indirect cost barriers must be addressed and access to free oral PrEP simplified. Finally, enthusiastic adopters must be introduced to CAB-LA, with integrated STI test-and-treat programs to reduce behavioural risks.

“Holistic strategies that combine education, accessibility, and PrEP innovations are essential to achieving national PrEP targets among Filipino MSM and TGIs,” he added.

In this study, Olete and his team developed LCA models using STATA. They stratified the population into subgroups based on associations between variables (ie, PrEP awareness, willingness towards various PrEP options), willingness to pay, and sexual behaviours (eg, multiple sexual partners, condom use). Significant covariates of class membership were identified using multinomial logistic regression.