Study Aim: To understand men who have sex with men’s (MSM) preferences for HIV prevention technologies and differentiated PrEP service delivery models in Zanzibar in preparation for the rollout of emerging PrEP technologies.
Background:
Despite a low HIV prevalence in the general population of Zanzibar, MSM experience a disproportionate burden of HIV, with an estimated HIV prevalence of 11.4%. MSM in Zanzibar also face significant stigma, discrimination, and barriers to healthcare access, which contribute to low awareness and uptake of pre-exposure prophylaxis (PrEP). Although oral PrEP is highly effective for HIV prevention, uptake and continuation remain limited due to stigma at healthcare facilities, low awareness, mistrust of providers, and challenges accessing youth- and key population-friendly care. Emerging HIV prevention technologies, including long-acting injectable PrEP, biannual injectable PrEP, and monthly oral PrEP, may help address some of these barriers, but little is known about MSM preferences for these technologies or how services should be delivered to support uptake and sustained engagement in care.
This study builds on prior discrete choice experiment (DCE) research conducted among female sex workers in Zanzibar, which identified strong preferences for long-acting PrEP options, pharmacy-based screening, and nurse-led adherence support. The proposed research aimed to extend this work to MSM in order to better understand HIV prevention preferences among another highly impacted key population and inform future differentiated HIV prevention programming in Zanzibar.
Study Overview:
The project used a mixed-methods approach combining a DCE and focus group discussions to evaluate MSM preferences for HIV prevention technologies and service delivery approaches in Zanzibar. The DCE assessed preferences for different PrEP modalities and program implementation characteristics, including pharmacy-based PrEP delivery, healthcare provider type, adherence support, and cost considerations. Educational modules and illustrated reference guides were used to support participant understanding of PrEP products and DCE choice tasks.
Specific Aims:
- Determine preferences for PrEP technologies and implementation models: Using a discrete choice experiment (DCE) among 450 MSM, identify preferences for PrEP technologies, including oral daily PrEP, bimonthly injectable PrEP, biannual injectable PrEP, and monthly oral PrEP, as well as preferred implementation features such as care location, potential cost, and adherence support.
- Contextualize DCE findings through focus group discussions: Conduct two focus group discussions (FGDs) with MSM following DCE analysis to validate findings, explore preferences for differentiated service delivery models, and identify additional HIV prevention and sexual health needs, including STI prevention and adherence support.
Inclusion Criteria: Men who reported anal sex (receptive or insertive) with another man within the past two years and self-reported being HIV seronegative were eligible to participate in the study.