{
  "abstract": "Introduction: South Africa has expanded access to pre-exposure prophylaxis (PrEP), yet men remain under-represented. Event-driven pre-exposure prophylaxis (ED-PrEP), taken around episodes of sexual activity, offers an effective non-daily option for cisgender men with intermittent sexual exposure. However, evidence on ED-PrEP in South Africa remains limited. We assessed ED-PrEP awareness and understanding, acceptability and willingness to pay (WTP) among cisgender men in Cape Town, South Africa. Methods: We conducted a cross-sectional survey among 150 cisgender men attending community-based mobile clinics in October-November 2025. Acceptability was assessed using five-point Likert items aligned with the Theoretical Framework of Acceptability (TFA). WTP was elicited using a contingent valuation bidding game. Amounts were elicited in South African rand (ZAR) and converted to United States dollars (US$). Open-text responses were coded using a predefined framework. Modified Poisson regression examined associations with acceptability and positive WTP (WTP>US$0); gamma regression examined stated maximum WTP amount among men reporting WTP>US$0. Results: Median age was 31 years (interquartile range [IQR] 26-41). Prior ED-PrEP awareness was 24.7%; among those aware (n=37), 40.5% demonstrated correct understanding. ED-PrEP was acceptable to 86.7%. The largest unadjusted TFA associations with acceptability were observed for self-efficacy (unadjusted prevalence ratio [uPR] 3.00, 95% CI 1.54-5.83) and intervention coherence (uPR 2.25, 95% CI 1.05-4.83). Among men who found ED-PrEP acceptable (n=130), 30.8% accepted the initial bid of US$16.64; 10.0% reported WTP=US$0. Median stated maximum WTP was US$5.55 (IQR: US$2.77-US$16.64). Men who did not know some or all partners' HIV status were more likely to report WTP>US$0 than men who knew all partners' HIV status (adjusted prevalence ratio [aPR] 1.17, 95% CI 1.01-1.36). Among men with WTP>US$0, those earning [≥]US$554.63 monthly had an expected mean WTP amount 82% higher than those earning <US$277.32 (adjusted mean ratio [aMR] 1.82, 95% CI 1.11-2.97). Conclusions: ED-PrEP was highly acceptable despite low prior awareness and limited correct understanding. Acceptability was linked to perceived understanding and confidence in using the regimen. WTP was common but price-sensitive, and higher income was associated with higher stated maximum WTP. Implementation should combine clear dosing education with free or subsidised access.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "name": "Mazvita Shereen Mnangagwa-Matsa",
      "orcid": "0009-0007-2137-9389"
    },
    {
      "name": "Juliana Kagura",
      "orcid": "0000-0002-6608-6930"
    },
    {
      "name": "Elzette Rousseau",
      "orcid": "0000-0002-6487-6736"
    },
    {
      "name": "Linda-Gail Bekker",
      "orcid": "0000-0002-0755-4386"
    },
    {
      "name": "Lawrence Long",
      "orcid": "0000-0003-4986-4988"
    },
    {
      "name": "Jacqui Miot",
      "orcid": "0000-0001-7070-3826"
    },
    {
      "name": "Cheryl Hendrickson",
      "orcid": "0000-0002-2744-5208"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/ecqb8ejn6ahha.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.30.26366952",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366952v1.full",
  "id": "ecqb8ejn6ahha",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366952v1",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Article"
    ],
    [
      "medrxiv",
      "health economics"
    ],
    [
      "openalex",
      "2725|HIV/AIDS Research and Interventions"
    ]
  ],
  "openalex": "W7225053651",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366952v1.full.pdf",
  "pmcid": "PMC13734192",
  "pmid": "42990678",
  "published": "2026-10-30",
  "publisher": "Cold Spring Harbor Laboratory Preprints",
  "ris": "https://research.draconitic.com/paper/ecqb8ejn6ahha.ris",
  "sources": [
    {
      "first_seen": "2026-11-02T12:20:44Z",
      "native_id": "10.64898/2026.10.30.26366952",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366952v1"
    },
    {
      "first_seen": "2026-11-08T12:23:49Z",
      "native_id": "PMC13734192",
      "source": "pmc",
      "url": "https://doi.org/10.64898/2026.10.30.26366952"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:health economics",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "ASSESSING THE ACCEPTABILITY OF, AND WILLINGNESS TO PAY FOR, EVENT-DRIVEN PRE-EXPOSURE PROPHYLAXIS AMONG CISGENDER MEN IN CAPE TOWN, SOUTH AFRICA",
  "title_text": "ASSESSING THE ACCEPTABILITY OF, AND WILLINGNESS TO PAY FOR, EVENT-DRIVEN PRE-EXPOSURE PROPHYLAXIS AMONG CISGENDER MEN IN CAPE TOWN, SOUTH AFRICA",
  "type": "preprint",
  "updated_at": "2026-11-08T12:23:49Z",
  "url": "https://research.draconitic.com/paper/ecqb8ejn6ahha",
  "venue": "medRxiv",
  "versions": []
}