Preferences for Conditional Economic Incentives to Improve Pre-exposure Prophylaxis Adherence: A Discrete Choice Experiment Among Male Sex Workers in Mexico

Aarón Salinas-Rodríguez, Sandra G Sosa-Rubí, Carlos Chivardi, Roxana Rodríguez-Franco, Monica Gandhi, Kenneth H Mayer, Don Operario, Nathalie Gras-Allain, Galileo Vargas-Guadarrama, Omar Galárraga, Aarón Salinas-Rodríguez, Sandra G Sosa-Rubí, Carlos Chivardi, Roxana Rodríguez-Franco, Monica Gandhi, Kenneth H Mayer, Don Operario, Nathalie Gras-Allain, Galileo Vargas-Guadarrama, Omar Galárraga

Abstract

Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV but requires sustained adherence. Conditional economic incentives (CEIs) can improve medication-taking behaviors, yet preferences for programs that employ CEIs to increase PrEP use among male sex workers (MSWs) have not been investigated. We conducted a discrete choice experiment in Mexico City to elicit stated preferences for a CEI-based PrEP adherence program among MSWs. Respondents expressed their preferences for different program characteristics: incentive amount; incentive format; incentive type; and adherence-verification method. We used a random utility logit model to estimate the relative importance of each attribute and estimated willingness-to-pay. MSWs preferred a higher, fixed incentive, with PrEP adherence measured via hair sampling. MSWs were willing to forego up to 21% of their potential maximum CEI amount to ensure receipt of a fixed payment. MSWs are highly willing to accept a CEI-based intervention for PrEP adherence, if offered along with fixed payments.

Keywords: Adherence; Discrete choice experiment; HIV; Male sex workers; PrEP; Willingness to accept.

Conflict of interest statement

Conflicts of interest/Competing interests. The authors declare that there is no conflict of interest.

© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Figures

Figure 1.
Figure 1.
Relative attribute influence for the Discrete Choice Experiment

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