Systematic Review of Preferences for Preexposure Prophylaxis Among Persons Assigned Male at Birth in the United States

ABSTRACT: Despite proven HIV prevention efficacy, preexposure prophylaxis (PrEP) uptake among individuals assigned-male-at-birth remains suboptimal; understanding their preferences is crucial. We conducted PRISMA-guided systematic review of stated-preference methods (i.e., discrete choice experiments [DCEs]; best-worst-scale [BWS], adaptive choice-based conjoint analysis [ACBCA]) through November 21, 2024. Of 648 records, 10 met inclusion (eight DCEs and two ACBCAs); all enrolled men who have sex with men (MSM; no studies with transgender women participants). Attributes included out-of-pocket cost, side effects, dosing frequency (daily oral vs. long-acting injectables), and accessibility. Cost, dosing frequency/method, and side effects most influenced MSM PrEP uptake. Uptake among MSM in the United States remains low due to stigma, misinformation, provider bias, cost, and limited affirming care; gender-diverse participants are underrepresented, and subgroup differences by race, age, and geography are seldom explored. Expanding culturally competent, gender-affirming care, peer-led education, and policy interventions is essential to strengthen PrEP engagement and equity.