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

BackgroundLong-acting injectable HIV pre-exposure prophylaxis (LAI-PrEP) offers potentials for expanding PrEP coverage and improving public health outcomes. This study synthesises global 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 cis-gender heterosexual women. MethodsWe conducted a global systematic review and meta-analysis, building on quantitative studies from a previous review (January 1, 2010, to September 27, 2021) and new studies published in PubMed, Web of Science, and Embase (September 27, 2021, to December 31, 2023). Studies presenting data on LAI-PrEP interest, preference, and their determinants were included. Data were assessed for risk of bias and publication bias. We used a random-effects meta-analysis to pool prevalence of LAI-PrEP interest and preference, and narratively synthesized their determinants across all key populations. This study is registered with PROSPERO, CRD42023488350. FindingsWe included 41 articles (18 from the previous systematic review and 23 from the new search). 74% (95%CI 71-78) of MSM showed interest in using LAI-PrEP and 37% (95%CI 29-44) of them preferring 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 reported that 57% of transgender women preferred for LAI-PrEP. Cis-gender heterosexual women also showed a high preference for LAI-PrEP (55%, 95%CI 40-70)). Overall, people who have more resources and who are already aware and using oral PrEP are likely more interested in LAI-PrEP when it becomes available. InterpretationContinued 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. FundingNone.