Willingness to Use HIV Pre-Exposure Prophylaxis (Prep) and Preferences for a Pharmacy-Based Prep Program Among Men Who Have Sex with Men

The purpose of this dissertation was to: 1) estimate willingness to use PrEP (WTUP) among men who have sex with men (MSM) using meta-analysis; 2) to assess patterns of minority stressors, HIV/AIDS acquisition stress and PrEP stigma among MSM and evaluate the association of such patterns with WTUP, using latent profile analysis; and 3) to elicit MSM’s preferences for a community pharmacy-based PrEP delivery program, using a discrete choice experiment. First, a meta-analysis using a random-effects model revealed a moderate pooled prevalence proportion for WTUP of 0.58 (95% CI: 0.54-0.61) (or 58 out of 100) among PrEP naïve MSM estimated from 15 included articles. Age and region significantly moderated the effect estimate. The factors associated with WTUP reported in these studies were categorized according to the Social Ecological Model. Few studies assessed and reported societal or public policy related factors associated with WTUP. Second, of the 390 MSM included in the study sample, 79.23% were willing to use PrEP. Two distinct classes were identified: 1) a “Lower Stress” class (81.79% of the respondents) and 2) a “Higher Stress” class. Predictors of the “Higher Stress” class membership were younger age, injection equipment sharing, prior STD diagnosis or depressive symptoms. After adjusting for covariates, WTUP was not different in the two classes. Therefore, PrEP programs in the future should incorporate counseling and peer support to empower MSM to cope with such stressors. Third, the respondents’ preferences clustered into four groups: 1) “Same day results and online monitoring” group (61.03% of the sample), 2) “Consumerist decision making” group (15.90% of the sample), “Self-screening (online questionnaire)” group (11.28% of the sample), and “Same day results preferring” group (9.49% of the sample). Race, region of residence, income and STD diagnosis were significant predictors of group membership. Community pharmacists should incorporate online screening and telehealth to have an effective program in their pharmacy