Abstract
BACKGROUND: Among Black women (BW), HIV prevalence is higher among women aged ⩾45 than among those aged <30 years. Pre-exposure prophylaxis (PrEP), a highly effective biomedical HIV prevention method, could be effective at reducing HIV incidence among this population. OBJECTIVES: To identify PrEP program features most important to aging BW and to examine how these preferences can inform program design using discrete choice experiment. DESIGN: We employed secondary data analysis using a choice-based conjoint analysis (CBC), a discrete choice experiment technique. METHODS: Between June and August 2024, 390 cisgender BW were recruited online, screened for eligibility, provided e-consent, and completed a one-time CBC survey of 14 choice tasks across 6 PrEP program attributes: (1) administration method, (2) access location, (3) healthcare integration, (4) provider demographics, (5) payment options, and (6) support services. We examined PrEP program preferences only among those aged ⩾45 (N = 83 of N = 390). Hierarchical Bayes model estimated attribute importance; latent class multinomial logit analysis grouped participants by similar preferences. RESULTS: PrEP administration method was the top-ranked attribute (39%), followed by provider demographics (14%) and payment options (13%). Preferences were clustered into three distinct groups. Group 1 (n = 8) showed higher proportions of worry about acquiring HIV and preferred only a daily pill by a doctor's office. Group 2 (n = 35) faced descriptively higher HIV vulnerability and favored injectable PrEP via telehealth supported (in-person) injection delivery from a female provider. Group 3 (n = 40) had the strongest interest and intention to use PrEP, preferring injectable PrEP from a pharmacist of the same race. Compared to the full sample, aging BW valued PrEP administration, prioritized gender matching alone, and payment options. CONCLUSION: PrEP program preferences are not uniform among aging BW. Rather than relying on a single PrEP delivery model, programs should be tailored to specific preferences for aging women who consider multiple factors and may need personalized support in PrEP decision-making.