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Background <p>Long-acting injectable cabotegravir (CAB-LA) pre-exposure prophylaxis (PrEP) has superior efficacy compared with daily oral PrEP. However, implementation in sub-Saharan Africa (SSA) is constrained by high costs and limited access. Assessing willingness to pay (WTP) is critical for the sustainable rollout of CAB-LA PrEP. This study evaluated WTP for CAB-LA PrEP among heterosexual male and female sex workers in Uganda.</p> Methods <p>Within a discrete choice experiment (DCE) to evaluate CAB-LA delivery preferences, we surveyed HIV negative heterosexual male and female sex workers (SWs) in two high prevalence cities in Central and Southwestern Uganda (October-December 2024). Willingness to pay (WTP) for injectable CAB-LA, including the maximum amount per injection, was assessed among sex workers (SWs) by trained interviewers. Trained interviewers collected data on WTP for injectable CAB-LA, including the maximum amount in Ugandan shillings (UGX) per injection. Modified Poisson regression was used to identify factors associated with WTP.</p> Results <p>We enrolled 251 sex workers (SWs), including 52 (21%) males. Males had higher education (27% vs. 5%), while females had been in the industry longer (24 months vs. 18 months). Females reported higher median weekly earnings (250,000 Ugandan shillings [UGX] [US $71.43]) than males (145,000 UGX [US $41.42]). Overall, 51% of females and 42% of males expressed WTP for injectable CAB-LA, with a median WTP of 10,000 UGX [$3], compared with the current average cost of 100,000 UGX [$29] in Uganda. WTP was positively associated with residing in Kampala (adjusted prevalence ratio [aPR] 2.41; 95% confidence interval [CI] 1.64–3.55) and with older age, including ages 25–30 years (aPR 1.51; 95% CI 1.03–2.22) and 31–35 years (aPR 1.87; 95% CI: 1.25–2.92), compared with ages 18–24 years. Higher WTP was also observed among respondents with previous PrEP use (aPR 1.52; 95% CI: 1.14–2.03), while no significant differences were observed by sex (aPR 0.96; 95% CI: 0.65–1.43).</p> Conclusions <p>This cohort of sex workers preferred injectable PrEP, but their willingness to pay remained modest. Future studies should assess the feasibility and effectiveness of out-of-pocket payment models for injectable PrEP programs.</p>

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Willingness to pay for injectable HIV pre-exposure prophylaxis among male and female sex workers in Uganda

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月18日

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  • Richard Muhindo,
  • Rachel King,
  • Andrew Mujugira,
  • Whitney Irie,
  • Freddy Eric Kitutu,
  • Ronald Olum,
  • Patience Muwanguzi,
  • Barbara Castelnuovo

摘要

Background

Long-acting injectable cabotegravir (CAB-LA) pre-exposure prophylaxis (PrEP) has superior efficacy compared with daily oral PrEP. However, implementation in sub-Saharan Africa (SSA) is constrained by high costs and limited access. Assessing willingness to pay (WTP) is critical for the sustainable rollout of CAB-LA PrEP. This study evaluated WTP for CAB-LA PrEP among heterosexual male and female sex workers in Uganda.

Methods

Within a discrete choice experiment (DCE) to evaluate CAB-LA delivery preferences, we surveyed HIV negative heterosexual male and female sex workers (SWs) in two high prevalence cities in Central and Southwestern Uganda (October-December 2024). Willingness to pay (WTP) for injectable CAB-LA, including the maximum amount per injection, was assessed among sex workers (SWs) by trained interviewers. Trained interviewers collected data on WTP for injectable CAB-LA, including the maximum amount in Ugandan shillings (UGX) per injection. Modified Poisson regression was used to identify factors associated with WTP.

Results

We enrolled 251 sex workers (SWs), including 52 (21%) males. Males had higher education (27% vs. 5%), while females had been in the industry longer (24 months vs. 18 months). Females reported higher median weekly earnings (250,000 Ugandan shillings [UGX] [US $71.43]) than males (145,000 UGX [US $41.42]). Overall, 51% of females and 42% of males expressed WTP for injectable CAB-LA, with a median WTP of 10,000 UGX [$3], compared with the current average cost of 100,000 UGX [$29] in Uganda. WTP was positively associated with residing in Kampala (adjusted prevalence ratio [aPR] 2.41; 95% confidence interval [CI] 1.64–3.55) and with older age, including ages 25–30 years (aPR 1.51; 95% CI 1.03–2.22) and 31–35 years (aPR 1.87; 95% CI: 1.25–2.92), compared with ages 18–24 years. Higher WTP was also observed among respondents with previous PrEP use (aPR 1.52; 95% CI: 1.14–2.03), while no significant differences were observed by sex (aPR 0.96; 95% CI: 0.65–1.43).

Conclusions

This cohort of sex workers preferred injectable PrEP, but their willingness to pay remained modest. Future studies should assess the feasibility and effectiveness of out-of-pocket payment models for injectable PrEP programs.