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Preferences for PrEP program attributes among Black women across the Southern United States: A discrete choice experiment
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JAIDS May 19, 2026
This study offers insights into preferences for PrEP delivery features among cisgender Black women in the US South, a group disproportionately affected by HIV. The PrEP administration method was the most influential factor in PrEP decision-making, indicating that product features, such as dosing frequency, ease of use, and discretion shape PrEP acceptability
among CBW.
LAI PrEP was the most preferred option, consistent with emerging research showing its appeal to women seeking convenience and privacy. The daily oral pill remained a strong alternative, indicating it continues to meet many women’s needs.
Provider characteristics emerged as the second most influential factor in PrEP decision-making, underscoring the importance of the patient-provider relationship. Participants strongly preferred providers who shared their race and gender.
Building on the need for affirming, discrimination-free care, the choice of access location ranked third in importance. Telehealth and pharmacies were the preferred settings, likely valued for convenience, accessibility, and privacy.
Telehealth may also reduce exposure to potentially discriminatory clinical encounters.68,70 Pharmacy-based access is increasingly recognized for convenience.
Background:
HIV disproportionately affects cisgender Black women (CBW), yet fewer than 2% of eligible CBW use pre-exposure prophylaxis (PrEP); an effective biomedical HIV prevention method. To improve PrEP uptake, this study identified CBW’s preferences for key features of PrEP delivery programs using a discrete choice experiment (DCE).
Methods:
CBW were recruited, screened online, and completed a one-time DCE survey. Participants completed 14 choice tasks involving 6 PrEP program attributes: 1) administration method, 2) access location, 3) healthcare integration, 4) provider demographics, 5) payment options, 6) support services. Hierarchical Bayes models estimated attribute importance; latent class analysis was used to group participants by similar preferences.
Results:
Among 390 participants, administration method was the top-ranked attribute (48%), followed by provider demographics (13.2%), and access location (12%).
Preferences clustered into five groups. Group 1 (n=82), younger women with high educational attainment, preferred telehealth initiated bi-monthly injectable PrEP. Group 2 (n=82), older women with lower HIV vulnerability, favored oral and injectable PrEP prescribed by a physician during women’s health visits. Group 3 (n=108) had the highest HIV vulnerability, showed strong interest in PrEP, preferred the vaginal ring accessed through pharmacies or telehealth. Group 4 (n=59) had the lowest access to healthcare, preferred injectable PrEP in clinical settings with income-based cost adjustments. Group 5 (n=59), one of the youngest and economically advantaged, favored the vaginal ring from a pharmacy.
Conclusion:
Findings indicate administration method, provider type, and access location mattered most to CBW for PrEP programming, indicating the need to use multiprong approaches to bolster PrEP uptake.
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