The awareness and preferences in PrEP access, type of service delivery, and willingness to pay among men who have sex with men in the Philippines: a discrete choice experiment
Rodenie Arnaiz Olete
A B * , Patrick Eustaquio A , Warittha Tieosapjaroen C , Kate Leyritana A , Michael Cassell D , Jason J. Ong C , Heather-Marie A. Schmidt E F , Nittaya Phanuphak G , Curtis Chan H and Benjamin R. Bavinton H
A
B
C
D
E
F
G
H
Abstract
The Philippines has witnessed a 550% increase in HIV cases between 2010 and 2023, disproportionately affecting men who have sex with men (MSM). Despite the national rollout of pre-exposure prophylaxis (PrEP) in 2021, uptake remains limited, with structural and individual barriers, such as PrEP-associated cost and stigma influencing engagement. This study explores Filipino MSM’s preferences for PrEP service attributes to inform person-centered HIV prevention strategies.
A cross-sectional online survey, as part of the PrEP APPEAL multicountry study, was conducted among MSM in the Philippines in May to November 2022. A discrete choice experiment embedded in the survey assessed preferences for six PrEP service attributes, including type, access location, cost, side-effects, visit frequency and additional services. Preferences were analyzed using random parameters logit and latent class models.
Among 2282 MSM respondents (mean age = 28.8 years, s.d. = 7.9), 68.9% had heard of PrEP, yet only 18.3% were current users. In the pooled analysis, cost, PrEP type, and side-effects were the most influential attributes. MSM preferred free oral PrEP but willing to pay up to Philippine Peso (PHP) 1000 (AUD 25) per month (β = 0.06, P = 0.032), services accessed through community-led clinics (β = 0.12, P = 0.001), and yearly clinic visits (β = 0.14, P < 0.001). The discrete choice experiment revealed four subgroups with diverse preferences: (1) the ‘Long-Acting Preventive Realists’ (27.3%), (2) the ‘Cost-Conscious Annually Visiting Pragmatist’ (22.1%), (3) the ‘Community-based organizations-Trusting Lowkey Clinic Visitors’ (33.0%), and the ‘Easy-Going PrEP-Hesitants’. Class 1 participants showed preferences across type of PrEP (29.2%), cost (26.5%) and side-effects (22.1%). In contrast, cost was the dominant factor for Classes 2 (54.9%), 3 (49.2%) and 4 (45.7%). Although, these latter classes also considered type of PrEP (11.6%, 15.2% and 16.5%, respectively) and side-effects (13.3%, 11.3% and 15.9%, respectively), but were less influential compared with Class 1. Across all classes, location and inclusion of extra services had relatively low importance.
Despite growing awareness, uptake among Filipino MSM remains limited. Findings highlight diverse user preferences, reinforcing the need for differentiated, person-centered PrEP models. Expanding community-based access, ensuring affordability and integrating user-informed features can optimize uptake, whereas sustainable financing and phased rollout of newer modalities are essential for national scale-up.
Keywords: awareness, discrete choice experiment, HIV pre-exposure prophylaxis, men who have sex with men, person-centered HIV prevention, the Philippines, willingness to adopt, willingness to pay.
References
1 Joint United Nations Programme on HIV/AIDS (UNAIDS). UNAIDS data 2024. 2024. Available at https://www.unaids.org/en/resources/documents/2024/2024_unaids_data [cited 22 April 2025]
2 Department of Health - Philippines. 2024 HIV & AIDS Surveillance of the Philippines (Q4 Report). 2024. Available at https://bit.ly/HASP2024Q4 [cited 19 April 2025]
3 van Griensven F, De Lind Van Wijngaarden JW, Eustaquio PC, Wignall S, Azwa I, Veronese V, et al. The continuing HIV epidemic among men who have sex with men and transgender women in the ASEAN region: implications for HIV policy and service programming. Sex Health 2021; 18: 21-30.
| Crossref | Google Scholar | PubMed |
4 AVAC. Data by Country - PrEPWatch. the Philippines: PrEPWatch Country Overview. Available at https://www.prepwatch.org/countries/philippines/ [cited 3 March 2025]
5 Department of Health - Epidemiology Bureau. 2022 integrated HIV behavioral and serologic surveillance (IHBSS). 2024. Available at https://bit.ly/2022IHBSS [cited 28 December 2024]
6 O Murchu E, Marshall L, Teljeur C, Harrington P, Hayes C, Moran P, et al. Oral pre-exposure prophylaxis (PrEP) to prevent HIV: a systematic review and meta-analysis of clinical effectiveness, safety, adherence and risk compensation in all populations. BMJ Open 2022; 12(5): e048478.
| Crossref | Google Scholar |
7 Coelho LE, Torres TS, Veloso VG, Landovitz RJ, Grinsztejn B. Pre-exposure prophylaxis 2.0: new drugs and technologies in the pipeline. Lancet HIV 2019; 6: e788-99.
| Crossref | Google Scholar | PubMed |
8 Hitchcock AM, Kufel WD, Dwyer KAM, Sidman EF. Lenacapavir: a novel injectable HIV-1 capsid inhibitor. Int J Antimicrob Agents 2024; 63(1): 107009.
| Crossref | Google Scholar |
9 Department of Health. Philippines-Interim-National-PrEP-Guidelines-2021. 2021. Available at https://www.prepwatch.org/resources/philippines-interim-national-prep-guidelines-2021/ [cited 15 December 2024]
10 Gangcuangco LMA, Eustaquio PC. The state of the HIV epidemic in the Philippines: progress and challenges in 2023. Trop Med Infect Dis 2023; 8: 258.
| Crossref | Google Scholar |
11 Department of Health - Epidemiology Bureau. 2024 HIV & AIDS Surveillance of the Philippines (Q3 Report). 2024. Available at https://bit.ly/HASP2024Q3 [cited 28 December 2024]
12 Olete RA, Leyritana K, Anigan GM, Gonzales J, Daclison J, Strong C. #SAILteleprep: utilizing RE-AIM framework in evaluating telehealth-based differentiated PrEP service delivery across four clinics in the Philippines [preprint]. Posted 10 March 2025. Available at http://dx.doi.org/10.2139/ssrn.5169439
13 Rosadiño JDT, Pagtakhan RG, Briñes MT, Dinglasan JLG, Cruz DP, Corciega JOL, et al. Implementation of unassisted and community-based HIV Self-Testing (HIVST) during the COVID-19 pandemic among Men-who-have-sex-with-Men (MSM) and Transgender Women (TGW): a demonstration study in Metro Manila, the Philippines. PLoS ONE 2023; 18(3): e0282644.
| Crossref | Google Scholar |
14 Eustaquio PC, Figuracion R, Jr, Izumi K, Morin MJ, Samaco K, Flores SM, et al. Outcomes of a community-led online-based HIV self-testing demonstration among cisgender men who have sex with men and transgender women in the Philippines during the COVID-19 pandemic: a retrospective cohort study. BMC Public Health 2022; 22(1): 366.
| Crossref | Google Scholar |
15 Antonini M, Silva IEd, Elias HC, Gerin L, Oliveira AC, Reis RK. Barriers to pre-exposure prophylaxis (Prep) use for HIV: an integrative review. Rev Bras Enferm 2023; 76: e20210963.
| Crossref | Google Scholar |
16 Thomas D, Mujugira A, Ortblad K, Namanda S, Kibuuka J, Nakitende M, et al. A pragmatic approach to identifying implementation barriers and facilitators for a novel pre-exposure prophylaxis (PrEP) delivery model at public facilities in urban Uganda. Implement Sci Commun 2022; 3(1): 7.
| Crossref | Google Scholar |
17 Yi S, Tuot S, Mwai GW, Ngin C, Chhim K, Pal K, et al. Awareness and willingness to use HIV pre-exposure prophylaxis among men who have sex with men in low- and middle-income countries: a systematic review and meta-analysis. J Int AIDS Soc 2017; 20: 21580.
| Crossref | Google Scholar |
18 Dean LT, Nunn AS, Chang H-Y, Bakre S, Goedel WC, Dawit R, et al. Estimating the impact of out-of-pocket cost changes on abandonment of HIV pre-exposure prophylaxis. Health Aff 2024; 43(1): 36-45.
| Crossref | Google Scholar |
19 World Health Organization (WHO). Update to WHO implementation guidance TECHNICAL BRIEF Differentiated and simplified pre-exposure prophylaxis for HIV prevention. 2022. Available at https://www.who.int/publications/i/item/9789240053694 [cited 15 December 2024]
20 Pettifor A, Nguyen NL, Celum C, Cowan FM, Go V, Hightow-Weidman L. Tailored combination prevention packages and PrEP for young key populations. J Int AIDS Soc 2015; 18: 19434.
| Crossref | Google Scholar |
21 Olete RA, Strong C, Leyritana K, Bourne A, Ko N-YM. ChemsexPH: the association between chemsex, HIV status and adherence to antiretroviral therapy among men who have sex with men in the Philippines. J Int AIDS Soc 2024; 27: 26323.
| Crossref | Google Scholar |
22 Eustaquio PC, Burnett J, Prejean J, Chapin-Bardales J, Cha S. Changes in HIV preexposure prophylaxis awareness and use among men who inject drugs who have sex with men by sexual identity in 19 US urban areas. AIDS 2024; 38(15): 2086-92.
| Crossref | Google Scholar | PubMed |
24 Soekhai V, de Bekker-Grob EW, Ellis AR, Vass CM. Discrete choice experiments in health economics: past, present and future. Pharmacoeconomics 2019; 37: 201-26.
| Crossref | Google Scholar | PubMed |
25 Jonker MF, Roudijk B, Maas M. The sensitivity and specificity of repeated and dominant choice tasks in discrete choice experiments. Value Health 2022; 25: 1381-9.
| Crossref | Google Scholar | PubMed |
26 Dubov A, Altice FL, Gutierrez JI, Wickersham JA, Azwa I, Kamarulzaman A, et al. Pre-exposure prophylaxis service among men who have sex with men in Malaysia: findings from a discrete choice experiment. Sci Rep 2023; 13(1): 14200.
| Crossref | Google Scholar |
27 Hauber AB, González JM, Groothuis-Oudshoorn CGM, Prior T, Marshall DA, Cunningham C, et al. Statistical methods for the analysis of discrete choice experiments: a report of the ISPOR conjoint analysis good research practices task force. Value Health 2016; 19(4): 300-15.
| Crossref | Google Scholar | PubMed |
28 R Core Team. R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2024. Available at https://www.r-project.org/ [cited 7 June 2025]
29 Econometric Software Inc. NLOGIT. Plainview, New York, USA; 2016. Available at https://www.limdep.com/ [cited 7 June 2025]
30 Zhang G, Yang X, Kang W, Liu T, Cheng L, Qu M, et al. Pre-exposure prophylaxis uptake for high-risk men who have sex with men in China: a multi-city cross-sectional survey. AIDS Res Ther 2023; 20(1): 32.
| Crossref | Google Scholar |
31 Apreku A, Guure C, Dery S, Yakubu A, Abu-Ba’are GR, Addo SA, et al. Awareness, willingness, and uptake of pre-exposure prophylaxis (PrEP) among men who have sex with men in Ghana. BMC Infect Dis 2025; 25(1): 213.
| Crossref | Google Scholar |
32 Liu Y, Liu X, Wei S, Cheng Z, Xian Y, Zhao Y, et al. Identifying patterns of sexual behaviors and PrEP uptake characteristics among MSM who were eligible for PrEP: a national cross-section study. J Virus Erad 2024; 10(2): 100382.
| Crossref | Google Scholar |
33 Wirawan GBS, Schimdt H-M, Chan C, Fraser D, Ong JJ, Cassell M, et al. PrEP use and willingness cascades among GBMSM in 15 Asian countries/territories: an analysis of the PrEP APPEAL survey. J Int AIDS Soc 2025; 28: e26438.
| Crossref | Google Scholar |
34 Cerchiari N, Grangeiro A, Massa P, Santos AC, de Soárez PC. PrEP demand creation strategies for adolescents at increased risk of HIV infection in São Paulo, Brazil: a cost-consequence analysis. BMC Health Serv Res 2025; 25(1): 246.
| Crossref | Google Scholar |
35 Phanuphak N, Sungsing T, Jantarapakde J, Pengnonyang S, Trachunthong D, Mingkwanrungruang P, et al. Princess PrEP program: the first key population-led model to deliver pre-exposure prophylaxis to key populations by key populations in Thailand. Sex Health 2018; 15(6): 542-55.
| Crossref | Google Scholar | PubMed |
36 Weir BW, Wirtz AL, Chemnasiri T, Baral SD, Decker M, Dun C, et al. High PrEP uptake, adherence, persistence and effectiveness outcomes among young Thai men and transgender women who sell sex in Bangkok and Pattaya, Thailand: findings from the open-label combination HIV prevention effectiveness (COPE) study. Lancet Reg Health 2023; 15: 100217.
| Crossref | Google Scholar |
37 Sell J, Chen R, Huber C, Parascando J, Nunez J. Primary care provider HIV PrEP knowledge, attitudes, and prescribing habits: a cross-sectional survey of late adopters in rural and suburban practice. J Prim Care Community Health 2023; 14: 21501319221147254.
| Crossref | Google Scholar |
38 Department of Health (Philippines). Department Circular No. 2024-0507: HIV Pre-Exposure Prophylaxis (PrEP) Programmatic Targets (2024–2026). Manila; 2024. Available at https://doh.gov.ph/dpcb/omnibus-health-guidelines
39 Muschialli L, Ford JV, Gonsalves L, Pralat R. Prevent with pleasure: a systematic review of HIV public communication campaigns incorporating a pleasure-based approach. PLOS Glob Public Health 2025; 5(3): e0004005.
| Crossref | Google Scholar |
40 World Health Organization. Long-acting injectable cabotegravir for HIV prevention. Geneva; 2022. Available at https://www.who.int/publications/i/item/9789240054097 [cited 23 April 2025]
42 Doblecki-Lewis S, Johnson A, Klose K, King K, Narcisse G, Butts S, et al. An observational cohort study evaluating PrEP reach, engagement and persistence through a community-based mobile clinic in Miami-Dade County, Florida. J Int AIDS Soc 2024; 27: 26362.
| Crossref | Google Scholar |
43 Rousseau E, Julies RF, Madubela N, Kassim S. Novel platforms for biomedical HIV prevention delivery to key populations — community mobile clinics, peer-supported, pharmacy-led PrEP delivery, and the use of telemedicine. Curr HIV/AIDS Rep 2021; 18: 500-7.
| Crossref | Google Scholar | PubMed |
44 Phan JM, Kim S, Linh ĐTT, Cosimi LA, Pollack TM. Telehealth interventions for HIV in low- and middle-income countries. Curr HIV/AIDS Rep 2022; 19: 600-9.
| Crossref | Google Scholar | PubMed |
46 Santos LAD, Deus LFAd, Unsain RF, Leal AF, Grangeiro A, Couto MT. Agreements and disagreements between professionals and users about the experience of a telehealth service for HIV pre-exposure prophylaxis (TelePrEP): qualitative interview study. J Med Internet Res 2025; 27: e67445.
| Crossref | Google Scholar |
47 Lancsar E, Swait J. Reconceptualising the external validity of discrete choice experiments. Pharmacoeconomics 2014; 32(10): 951-65.
| Crossref | Google Scholar | PubMed |
48 Hensher DA. Hypothetical bias, choice experiments and willingness to pay. Transp Res Part B Methodol 2010; 44(6): 735-52.
| Crossref | Google Scholar |
49 Quaife M, Terris-Prestholt F, Di Tanna GL, Vickerman P. How well do discrete choice experiments predict health choices? A systematic review and meta-analysis of external validity. Eur J Health Econ 2018; 19(8): 1053-66.
| Crossref | Google Scholar | PubMed |
