The “PrEP APPEAL” of less frequent dosing: acceptability of six-monthly long acting-injectable PrEP among gay and other men who have sex with men and transgender women in Asia

Background: Pre-exposure prophylaxis (PrEP) use in Asia is 3% of estimated need. Lenacapavir, a highly efficacious new six-monthly long-acting injectable (LAI) PrEP option, could bridge this gap. Methods: Data were derived from PrEP APPEAL, an online cross-sectional survey among HIV-negative men who have sex with men (MSM) and transgender women (TGW) aged 18 years or older, in 15 and 11 Asian countries/territories, respectively, in May- November 2022. Survey items included PrEP awareness, willingness to use and top preference for different PrEP products. Multivariable logistic regression examined factors associated with preference for a six-monthly LAI versus other PrEP products. Results: Among 15,099 MSM and 1,233 TGW, PrEP awareness was 80.1% and 77.9%. Willingness to use PrEP was 92.2% and 96.4% in MSM and TGW, respectively, while willingness to use a six-monthly LAI was 33.8% and 31.6%, compared with 60.6% and 59.6%, respectively, for oral PrEP, and varied substantially between countries. A six-monthly LAI was the top preference for 18.8% and 20.6% of MSM and TGW, lower than oral PrEP at 43.7% and 47.8% respectively. Substantial variation was observed between countries, with the lowest willingness in Cambodia (19.9% for MSM and 11.8% for TGW), while in Singapore (42.1%) and Malaysia (54.6%) among MSM and TGW respectively. Conclusions: Approximately one-third of Asian MSM and TGW were willing to use six-monthly LAI-PrEP, and it was the top preference for almost 20%. Offering a six-monthly LAI PrEP as an additional prevention choice could increase PrEP coverage and help meet unmet PrEP demand in Asia.