OBJECTIVES: Pre-exposure prophylaxis (PrEP) is effective in preventing HIV-1; however, only 25–30% of people who could benefit from PrEP (PWBP) in the US use it. We performed qualitative research to identify factors influencing PrEP use.

METHODS: Interviews were conducted with PWBP in the US between February–May 2023. Participants were recruited using a patient panel and engagement database qualified by PrEP use status: PrEP-naïve (PN; [never used PrEP and met criteria indicative of potentially benefitting from PrEP]), current PrEP user (CP), and former PrEP user (FP). The moderator followed a semi-structured guide to identify factors impacting PrEP uptake, use, and PrEP-attribute preferences. Verbatim transcripts were coded using qualitative analysis software to identify emerging themes.

RESULTS: Twenty PWBP participated: 10 PN, 5 CPs, and 5 FPs. PN participants were less likely to undergo regular HIV testing and had a lower perceived risk of getting HIV versus CPs and FPs; a higher perceived risk appeared to be driven by sexual behavior and lack of information about partner history. In CP/FP groups, PrEP initiation was influenced by sexual behavior and physician trust and empathy. In FPs, reasons for stopping PrEP included adherence challenges, side effects, and sexual-behavioral changes. All groups said they felt empowered by PrEP, although stigmatization concerns were reported. All groups noted that efficacy, side effects, and cost were key factors influencing PrEP uptake. When considering oral or injectable (subcutaneous or intramuscular) PrEP, all groups expressed a preference for injectables (n=15/20), primarily driven by a preference for less frequent dosing.

CONCLUSIONS: This analysis highlights that barriers and drivers to PrEP use may be complex. Long-acting injectable PrEP may address challenges associated with PrEP uptake and use among persons who may benefit from PrEP. Emergent themes from this analysis have informed a future survey focusing on perceptions of PrEP attributes.