ASSESSING THE ACCEPTABILITY OF, AND WILLINGNESS TO PAY FOR, EVENT-DRIVEN PRE-EXPOSURE PROPHYLAXIS AMONG CISGENDER MEN IN CAPE TOWN, SOUTH AFRICA
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>US0); 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 US16.64; 10.0% reported WTP=US0. Median stated maximum WTP was US$5.55 (IQR: US2.77−US16.64). Men who did not know some or all partners' HIV status were more likely to report WTP>US0 than men who knew all partners' HIV status (adjusted prevalence ratio [aPR] 1.17, 95% CI 1.01−1.36). Among men with WTP>US0, those earning [≥]US554.63 monthly had an expected mean WTP amount 82% higher than those earning <US277.32 (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.
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BibTeX
@misc{mnangagwamatsa2026assessing,
title = {{ASSESSING THE ACCEPTABILITY OF, AND WILLINGNESS TO PAY FOR, EVENT-DRIVEN PRE-EXPOSURE PROPHYLAXIS AMONG CISGENDER MEN IN CAPE TOWN, SOUTH AFRICA}},
author = {Mazvita Shereen Mnangagwa-Matsa and Juliana Kagura and Elzette Rousseau and Linda-Gail Bekker and Lawrence Long and Jacqui Miot and Cheryl Hendrickson},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.30.26366952},
url = {https://www.medrxiv.org/content/10.64898/2026.10.30.26366952v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - ASSESSING THE ACCEPTABILITY OF, AND WILLINGNESS TO PAY FOR, EVENT-DRIVEN PRE-EXPOSURE PROPHYLAXIS AMONG CISGENDER MEN IN CAPE TOWN, SOUTH AFRICA
AU - Mazvita Shereen Mnangagwa-Matsa
AU - Juliana Kagura
AU - Elzette Rousseau
AU - Linda-Gail Bekker
AU - Lawrence Long
AU - Jacqui Miot
AU - Cheryl Hendrickson
PY - 2026
DA - 2026/10/30
PB - medRxiv
DO - 10.64898/2026.10.30.26366952
UR - https://www.medrxiv.org/content/10.64898/2026.10.30.26366952v1
AB - 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>US0); 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 US16.64; 10.0% reported WTP=US0. Median stated maximum WTP was US$5.55 (IQR: US2.77−US16.64). Men who did not know some or all partners' HIV status were more likely to report WTP>US0 than men who knew all partners' HIV status (adjusted prevalence ratio [aPR] 1.17, 95% CI 1.01−1.36). Among men with WTP>US0, those earning [≥]US554.63 monthly had an expected mean WTP amount 82% higher than those earning <US277.32 (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.
ER -