The most helpful questions in the new HIV prevention guide may be the questions you never ask. “Why do I want to know about pre-exposure prophylaxis (PrEP)?”
In a pilot study conducted in three clinics, a two-page decision-support tool helped people choose between a daily pill, long used for HIV prevention, and a new injection treatment given every two months, without disclosing details of their sex life or explaining why they wanted protection.
research in PLOS Global Public Health Detail patient responses to decision-making tools. Lead author Wendy Davis and lead author Deanna Kerrigan developed the tool with collaborators at the University of North Carolina at Chapel Hill and community partners in Washington, DC, while attending George Washington University and later joining the Rutgers School of Public Health. Davis currently serves as program director for research, development and training, Kerrigan serves as associate dean, and Henry Rutgers serves as chair of the Department of Whole Person Health.
This guide sets up two forms side by side. One panel explains the uses, effects, and side effects of each, and another panel discusses preferences such as whether to take a pill every day or go to a clinic for an injection.
This tool targets the awareness gap. When the research team first interviewed people who might benefit from PrEP, 80% had never heard of the injection, which was approved by the Food and Drug Administration in December 2021. Nationally, fewer than 1 in 200 prescriptions for PrEP were written. And by 2022, just 36% of the estimated 1.2 million Americans who could benefit from PrEP were using some form of PrEP, the researchers said.
According to participants, the tool is unique in that it lacks a risk assessment. Because they were never asked to explain their actions, they did not feel the need to justify their interest in PrEP. People described guides as a “third party in the room” and an “icebreaker” that “levels the playing field.”
The sense of relief was especially evident among people who aren’t necessarily considered candidates for PrEP, such as older adults.
We have many options to help protect and treat HIV and other areas. A major challenge in public health today is how to make people aware of these options so that they can use them to their benefit. ”
Wendy Davis, lead author
The lesson was almost clear, she said. “When you ask people what they want to know and how they want to receive it, and you do that, they love it. It helps them decide.”
The team wrote the English and Spanish versions of the guide in the simplest language possible.
The disparity that this tool aims for is wide. In 2023, women accounted for 8% of PrEP users, compared to 19% of new HIV diagnoses in the United States. Black Americans accounted for 39% of new diagnoses, but 14% of users.
The authors caution that the pilot used mock clinical visits rather than actual appointments, that responses may reflect a desire to please, and that one of the participating clinics may have an unusual experience with PrEP. They say a larger real-world trial is warranted. The tool is available for free in an open access study, and the authors said clinics are welcome to use it.
The study was funded through a contract with British pharmaceutical company ViiV Healthcare, which manufactures the injection.
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Reference magazines:
Davis, W.W. others. (2026). Developing and evaluating the acceptability of a shared decision-making tool for choosing among HIV pre-exposure prophylaxis options in the United States. PLOS Global Public Health. DOI: 10.1371/journal.pgph.0005557. https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0005557
