User Preferences on Long-Acting Pre-Exposure Prophylaxis for HIV Prevention in Sub-Saharan Africa: A Scoping Review

Background. Novel formulations for PrEP such as injectables, implants, and intravaginal rings are emerging as long-acting alternatives to daily pills for the prevention of HIV. Sub-Saharan Africa has the highest HIV burden as well as the highest PrEP coverage globally. As long-acting formulations continue to become available, it is crucial to understand the product preferences of potential users. Objective. To conduct a scoping review focused on the region of Sub-Saharan Africa to understand which PrEP products, especially long-acting formulations, different patients and demographic groups prefer as well as the factors that influence their preferences. Design. We identified 34 publications published between 2014 and 2024 that assessed preferences regarding at least one long-acting PrEP product in the region of Sub-Saharan Africa. Results. Participants preferred longer-acting products over oral pills when given the choice in almost all studies. On-demand PrEP was commonly preferred over daily dosing, and long-acting products were preferred over on-demand dosing. A majority of studies found injectables to be most commonly preferred compared to daily oral PrEP, implants, and rings. This preference was observed across a range of demographics including men and women, youth, men who have sex with men, and female sex workers. Duration, efficacy, and discretion were the three most important factors influencing participants' choices. Conclusions. Long-acting products, especially injectables, are acceptable for a wide range of individuals at risk of HIV in Sub-Saharan Africa and tend to be preferred over daily oral pills. Participants expressed a diversity of values and opinions regarding preferences, emphasizing the benefit of providing multiple formulations to maximize coverage over heterogeneous populations. Strength and Limitations of this Study Some key populations, such as transgender women, were underrepresented in the literature. With most studies published before long-acting products became widely available, the hypothetical preferences of non-experienced users may differ from preferences in practice. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was funded by the Bill and Melinda Gates Foundation (INV-038274). The funders had no role in the study design, data collection, or decision to publish this article. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript.