DCE choice sets with neither option.

Cisgender female sex workers (FSWs) in sub-Saharan Africa have a high risk of HIV acquisition, highlighting the need for innovative approaches to expand coverage of evidence-based HIV prevention methods, including oral pre-exposure prophylaxis (PrEP). Our study aimed to identify FSWs’ preferences for a PrEP delivery model with structured choices for delivery location, services offered, and adherence support. We conducted a discrete choice experiment (DCE) with female sex workers (FSWs) aged 18 and above at the Most At-Risk Population Initiative (MARPI) clinic in Kampala, Uganda, from October to November 2023. Participants were recruited consecutively. To identify the most preferred PrEP delivery model, we designed eight choice sets using a D-efficient design. Each set included three PrEP service options and an opt-out. Options varied by provider, delivery location, channel, and support services. Participants selected their preferred option in each set. Preferences and trade-offs were analyzed using a panel mixed model, and the highest median utility identified the top model. Overall, 203 participants completed the DCE. The median age was 24 years (interquartile range [IQR] 20–32). Most FSWs preferred receiving PrEP from a healthcare worker at the clinic with short message service (SMS) reminders for adherence support (median utility score 0.87; interquartile range [IQR] 0.82, 0.94). This preference remained consistent across all age groups, with a median utility score of 0.88 for ages 15–19, 0.87 for ages 20–24, and 0.85 for ages ≥25. FSWs preferred to receive PrEP care directly from providers at healthcare facilities and highlighted the need for additional support in the form of SMS reminders to improve adherence and prevent HIV acquisition. This preferred model, if implemented, could increase prevention coverage and inform future approaches to delivering PrEP through the Uganda National PrEP Program.撒哈拉以南非洲地区的顺性别女性性工作者（Cisgender female sex workers, FSWs）感染艾滋病病毒（HIV）的风险居高不下，凸显了需通过创新手段扩大循证艾滋病预防方法覆盖范围的迫切性，此类方法涵盖口服暴露前预防（PrEP）。本研究旨在明确女性性工作者对PrEP递送模式的偏好，该模式可在递送地点、服务内容及依从性支持方面提供结构化选择方案。研究团队于2023年10月至11月期间，在乌干达坎帕拉的高风险人群倡议（Most At-Risk Population Initiative, MARPI）诊所，对18岁及以上的女性性工作者开展了一项离散选择实验（discrete choice experiment, DCE），招募方式为连续入组。为筛选出最受青睐的PrEP递送模式，我们采用D最优设计构建了8组选择任务，每组任务包含3种PrEP服务选项与1个退出选项。各选项在服务提供者、递送地点、服务渠道及支持服务维度存在差异，参与者需在每组任务中选定自身偏好的选项。我们采用面板混合模型（panel mixed model）对参与者的偏好及权衡取舍进行分析，并以最高中位效用值确定最优递送模式。本研究共纳入203名完成离散选择实验的参与者，其年龄中位数为24岁（四分位距（interquartile range, IQR）：20~32）。绝大多数女性性工作者更倾向于在诊所由医护人员提供PrEP服务，并辅以短信服务（short message service, SMS）提醒以强化依从性支持，该偏好对应的中位效用得分为0.87（四分位距（IQR）：0.82~0.94）。该偏好于各年龄组中均保持一致：15~19岁组的中位效用得分为0.88，20~24岁组为0.87，25岁及以上组为0.85。女性性工作者更倾向于直接由医疗机构的医护人员提供PrEP护理，并强调需通过短信提醒等形式提供额外支持，以提升用药依从性、降低HIV感染风险。若该优选模式得以落地实施，有望扩大艾滋病预防措施的覆盖范围，并为乌干达国家PrEP计划未来的PrEP递送方案优化提供科学参考。