Despite the wide implementation of HIV oral pre-exposure prophylaxis (oPrEP), uptake, adherence and persistence issues remain. Long-acting injectable cabotegravir (CAB-LA) is a promising new PrEP HIV prevention option. However, little is known about oPrEP users’ interest in it. We investigated men who have sex with men (MSM) oPrEP users’ willingness to participate (WtP) in a CAB-LA PrEP study in France.
We designed a cross-sectional questionnaire (‘NewPrEP’) to evaluate attitudes to CAB-LA of daily and event-driven oPrEP users participating in the ANRS-PREVENIR cohort study (2017–2025). The outcome, WtP, was dichotomised into ‘Willing’ (absolutely/probably) or ‘Unwilling’ (probably not/absolutely not/I would like to discuss this with my doctor before making a decision). We used multivariate logistic Bayesian model averaging to estimate factors associated with WtP.
Of the 1555 MSM followed in ANRS-PREVENIR in February 2023 with baseline data, 879 (57%) answered the NewPrEP questionnaire. Median age and follow-up time were 38 and 4.7 years, respectively; 37% and 22% were on daily- and event-driven oPrEP, respectively; 41% used a combination of both regimens. 64% had heard of CAB-LA PrEP, and 43% were WtP in a related study. Multivariate results showed that willing participants were younger and more likely to have heard of CAB-LA, to use daily oPrEP exclusively or in combination, to find it difficult to adhere to their regimen, to engage in chemsex, to trust their doctor and to be more interested in PrEP effectiveness than in the administration mode. They were less likely to perceive the obligatory 2-monthly hospital visits for CAB-LA PrEP as constraining, to be scared of injections and to fear long-acting medications.
WtP in a CAB-LA study among MSM oPREP users was moderate but concentrated among those with the greatest need. This highlights the need to enable free distribution. Future studies should evaluate adherence and retention in long-acting iPrEP.