Preferences for models of sexual health service delivery among gay, bisexual and other men who have sex with men in Australia: a discrete choice experiment.

The study recruited 1422 participants across three groups with differing demographic profiles.

• 396 gay, bisexual and other men who have sex with men (GBM) living with HIV (median age 41, IQR: 32-54)
• 436 PrEP users (median age 35, IQR: 29-45)
• 590 non-PrEP users (median age 33, IQR: 26-44)
• Participants were recruited via paid advertisements, sexual health clinics, and community networks
• Cross-sectional online survey conducted from November 2022 to February 2023

GBM living with HIV were distributed across three latent preference classes for sexual health service delivery.

• 46.2% preferred sexual health clinics
• 33.0% preferred GPs with expertise in LGBTQ+ health
• 20.7% were willing to go anywhere and willing to pay for services
• Latent class analysis was used to identify subgroups with similar preferences

PrEP users were divided into two latent preference classes, both involving GPs with expertise in LGBTQ+ health.

• 75.2% preferred either PrEP-only clinics or GPs with expertise in LGBTQ+ health
• 24.8% preferred GPs with expertise in LGBTQ+ health only
• All PrEP user preference classes involved LGBTQ+-competent GP care as a component

Non-PrEP users showed four distinct latent preference classes, including a substantial group that did not want to test.

• 44.7% preferred GPs with expertise in LGBTQ+ health
• 22.8% preferred any free service
• 22.2% did not want to test for HIV/STIs
• 10.2% were unsure of their preferences
• Testing reluctance was identified as a key concern unique to this group

Service delivery attributes examined in the discrete choice experiments included cost, clinic type, appointment type, appointment frequency, extra services, and sample collection location.

• Three tailored DCEs were developed, one for each participant group
• Attributes were designed to quantify preferences relevant to each group's likely service use
• Where samples are taken for HIV/STI testing was included as a distinct attribute
• Latent class analyses were applied to DCE data to identify preference subgroups

The study identified financial barriers as a concern, with a preference class among non-PrEP users specifically favouring free services.

• 22.8% of non-PrEP users preferred 'any free service', suggesting cost is a barrier to engagement
• 20.7% of GBM living with HIV were willing to pay and go anywhere, indicating cost was less of a barrier for some in that group
• Future research was recommended to focus on addressing financial barriers to sexual health services

The authors concluded that investment in both specialist sexual health clinics and LGBTQ+-competent GPs is important to align service models with client needs.

• Specialist sexual health clinics were preferred by the largest single class of GBM living with HIV (46.2%)
• LGBTQ+-competent GPs featured in preferred service models across all three participant groups
• The authors noted that appropriate service investment 'may depend on local resources and infrastructure'
• Future research priorities identified included telehealth, digital health interventions, and understanding testing reluctance among non-PrEP users