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

Background 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. Methods 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. Results 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. Conclusions 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.