Interest in and preference for long-acting injectable PrEP among men who have sex with men, trans* individuals, and cis-gender heterosexual women: a global systematic review and meta-analysis

Long-acting injectable pre-exposure-prophylaxis (LAI-PrEP) offers potentials for expanding PrEP coverage and improving public health outcomes. This study synthesises evidence on the prevalence and determinants of interest in and preference for LAI-PrEP among men-who-have-sex-with-men (MSM), trans* individuals, and heterosexual women. We conducted this systematic review and meta-analysis building on quantitative studies from a previous review and new studies published in PubMed, Web of Science, and Embase up to December 31, 2023. We used a random-effects meta-analysis to pool the prevalence of LAI-PrEP interest and preference, and narratively synthesised their determinants across all key populations. We included 41 articles. 74% (95%CI:71-78) of MSM showed interest in using LAI-PrEP, and 37% (95%CI:29-44) of them preferred LAI-PrEP over other HIV prevention methods. The prevalence of interest and preference were even higher among current oral PrEP users (77% (95%CI:70-84), and 43% (95%CI:28-58), respectively). Interest in LAI-PrEP among trans* individuals was similarly high at 72% (95%CI:67-78), with one study reporting that 57% of transgender women preferred LAI-PrEP. Cis-gender heterosexual women also showed a high preference for LAI-PrEP (55%, 95%CI:40-70)). No significant differences were found between low-/middle-income countries and high-income countries across any key populations. Overall, people with more resources and who are already aware of and using oral PrEP are likely more interested in LAI-PrEP when it becomes available. Continued research is essential to effectively deploy LAI-PrEP and address HIV prevention gaps. As more countries adopt LAI-PrEP, understanding its impact and reaching underserved populations will be critical to maximising public health benefits.