OBJECTIVES: Daily oral pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV acquisition, but coverage remains low in high-prevalence settings. Initiating and continuing PrEP online is a novel alternative to clinic-based services that could provide greater privacy, potentially improving uptake and long-term coverage. We conducted a discrete choice experiment (DCE) to assess preferences for obtaining PrEP through an online pharmacy among probable clients in Kenya.

METHODS: We developed a DCE administered in-person and advertised for recruitment through “MYDAWA”, a private Kenyan online-pharmacy retailer. Our target population was ≥18 years old, without a positive HIV diagnosis, interested in PrEP, and living in Nairobi. In eight choice-tasks, participants selected between two alternatives defined by characteristics (and levels), which included: PrEP eligibility (self-assessment, guided), HIV-test type (oral or blood self-test, provider-performed), clinical consultation type (remote, in-person), and user support (text message, call, email). We analyzed the data using a conditional logit model with an alternative-specific-constant to estimate characteristic-levels’ strength of preferences (SP) and confidence intervals (95%CI).

RESULTS: From May to November 2022, 772 participants completed the survey. Participants were mostly female–54%, residing in Nairobi–47%, without prior online-pharmacy experience–75%, and a median age of 25 years. Participants preferred: online-assessment (SP=0.04; 95%CI=0.01,0.07) to guided-assessment (-0.04; -0.07,-0.01); self-test (0.15; 0.10,0.19) to provider-based (-0.16; -0.22,-0.09); remote-consultation (0.13; 0.09,0.18) to in-person (-0.13; -0.18,-0.09); and call support (0.11; 0.07,0.15) to email (-0.19; -0.23,-0.14). Across characteristics, ‘PrEP eligibility’ was the least influential in participant decision-making. Relative to ‘PrEP eligibility’, ‘clinical consultation’ was 3.25 times as important; ‘user support’, 3.24; and ‘HIV-test type’, 2.10.

CONCLUSIONS: Overall, participants demonstrated strong preferences for online rather than in-person services, except for ‘user support’, which may indicate a desire for more personalized services only when problems or questions arise. Findings can inform the development of effective online PrEP delivery strategies in Kenya and similar settings.