Perceptions of Long-Acting Injectable Pre-Exposure Prophylaxis Among Men Who Have Sex With Men and Transgender Individuals in Europe Using Structural Text Modeling Technique: Cross-Sectional Study
Bibliographic record
Abstract
BACKGROUND: Oral pre-exposure prophylaxis (PrEP) effectively prevents HIV but remains unevenly accessible across Europe. Long-acting PrEP (LA-PrEP), recently approved in Europe, offers new HIV protection options. However, no qualitative evidence is available to inform people's perceptions of this novel modality. OBJECTIVE: This study provides the first large-scale, qualitative evidence in English from 20 European countries on how men who have sex with men (MSM) and trans* individuals perceive LA-PrEP. METHODS: We analyzed open-ended responses from 3123 HIV-negative MSM and trans* individuals from 20 European countries who completed the PROTECT survey in English. Participants were asked to describe what LA-PrEP means to them using words or short phrases. We used word clouds for initial insights and structural topic modeling to identify topics and explore their relevance across socioeconomic status, migration background, oral PrEP use, and affordability and the association of these perceptions with LA-PrEP intention. RESULTS: The responses reflected generally positive associations toward LA-PrEP, with the most frequently mentioned word being "safe," "freedom," and "convenient." However, some ambivalent and negative perceptions, such as "nothing," "unknown," "dunno," and "unnecessary," were also noted. Structural topic modeling identified 5 main response topics: safety, empowerment, convenience/reliability, peace of mind, and concerns/uncertainties. The empowerment offered by LA-PrEP was the most prominent topic, representing one third (28.1%) of the responses, followed by safety (21%), convenience and reliability (16%), and peace of mind (15%), while concerns/uncertainties made up 20%. Variation in the relevance of these topics was found, showing LA-PrEP being seen as more empowering (=.070, 95% CI 0.042-0.097) and convenient (=.057, 95% CI 0.034-0.081) by current oral PrEP users, but less empowering (=-.052, 95% CI -0.087 to 0.017) and convenient (=-.034, 95% CI -0.064 to 0.005) for individuals in countries with limited oral PrEP access and affordability. The topic of safety was more relevant among those with lower levels of education (=.052, 95% CI 0.022-0.083) and those living in a country where PrEP was not reimbursed (=.035, 95% CI 0.002-0.069), but less relevant among current oral PrEP users (=-.094, 95% CI -0.12 to 0.066). We also found that ambivalent and negative perceptions were less relevant among current oral PrEP users (=-.032, 95% CI -0.056 to 0.007) and were negatively associated with a lower intention to use LA-PrEP (=-.075, 95% CI -0.101 to 0.005). CONCLUSIONS: Our research showed that MSM and trans* individuals in Europe generally have a positive outlook on LA-PrEP, suggesting it is likely to be well accepted upon its introduction in Europe. However, a subset of the target population may be hesitant to adopt LA-PrEP, underscoring the need for alternative HIV prevention strategies tailored to these individuals. To support potential future LA-PrEP implementation in Europe and to maximize its impact, appropriate communication strategies are essential for supporting informed decision-making.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".