Background
Background: New long-acting injectable (LAI) HIV pre-exposure prophylaxis (PrEP) products require less frequent dosing and are more discreet than the daily oral standard. Their implementation in diverse settings, including private pharmacies, may help enhance PrEP reach and coverage. We assessed PrEP product preferences among clients obtaining daily oral PrEP or post-exposure prophylaxis (PEP) at private pharmacies in Kenya.
Methods
Methods: At 60 pharmacies across Western and Central Kenya, clients (≥16 years) receiving PrEP or PEP through enrollment in a cluster-randomized controlled trial (cRCT; NCT05842122) were invited to complete surveys at enrollment, day 60, and day 270. The surveys collected demographics and PrEP product preferences from individual participants at each time point. Multivariable logistic regression adjusted for age, sex, marital status, and questionnaire timing identified factors associated with a preference for LAI PrEP (6- or 2-monthly) versus oral PrEP product.
Results
Results: From July 2023 to April 2025, 799 of 5904 (14%) enrolled cRCT clients completed questionnaires; 44% (352/799) were PEP (vs. PrEP) clients, 47% (376/799) female, and 38% (306/799) married. The median age was 28 years (IQR 24–35) and 3% (20/799) were members of a key population. A 2-monthly PrEP injection was preferred over daily oral PrEP by most clients (80%, 639/799); this preference persisted among clients even after they learned that this injection is administered in the buttock (96%, 613/639) and required one year of daily oral PrEP use if stopped and HIV risk was anticipated to continue (87%, 535/613). When female clients were given a monthly PrEP vaginal ring option, most still preferred the 2-monthly injection (68%, 256/376), followed by the daily pill (28%, 105/376), then the monthly ring (2%, 8/376). When a 6-monthly PrEP injection was presented as an option, 69% (553/799) of clients preferred that over a 2-monthly injection (10%, 77/799) or daily pill (21%, 167/799). Clients who identified as belonging to a key population were significantly less likely to prefer LAI PrEP product over daily oral PrEP (aOR 0.34, p=0.021); other client characteristics were not significantly associated with LAI PrEP preference.
Conclusions
Conclusion: Pharmacy oral PrEP and PEP clients in this Kenya-based cRCT preferred LAI PrEP products. During initial introduction of LAI PrEP, policymakers should consider private pharmacies to expand reach and coverage of biomedical HIV prevention services.