PONE-D-24-43968Preferences for on-demand/intermittent/event-driven and long-acting injectable (LAI) HIV pre-exposure prophylaxis (PrEP) among HIV-negative Black gay, bisexual, and other sexual minority men in the United States: A qualitative studyPLOS ONE

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Reviewer #1: Yes

Reviewer #2: Partly

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Reviewer #1: N/A

Reviewer #2: N/A

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Reviewer #1: Yes

Reviewer #2: No

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: This is a well-written and timely paper. I have a few minor suggestions to improve the paper. Please clarify the following points:

- It appears that each focus group included people who were on-PrEP, PrEP-naive, and who had discontinued PrEP. How could these different groups have influenced or biased each other in their responses during the focus group? Was this controlled for in any way?

- A more detailed description of the qualitative data analysis is warranted. How many coders were there? How was interrater reliability assessed? As many items as you can complete from the COREQ (https://www.hsph.harvard.edu/wp-content/uploads/sites/2448/2021/02/Consolidated-criteria-for-reporting-qualitative-research-COREQ.pdf) would be informative.

- Was any other data gathered to assess participants' risk behaviors and how/whether they varied? Or the reasons why some of them had discontinued or decided not to get on PrEP? These could be informative contexts for their preferences around PrEP.

Reviewer #2: This is an interesting study with important implications for the development of HIV prevention interventions. I am particularly impressed with the researchers’ ability to recruit current PrEP users, non-users, and discontinuers, and discuss differences in PrEP attitudes between these groups. However, this paper would benefit from reframing and significant reorganization. Specific comments and suggestions are provided below.

1. The authors present this as a study of Black gay, bisexual, and other sexual minority men. However, their eligibility criteria referred to sex assigned at birth—not gender—and not all participants identified as cisgender men. Additionally, the eligibility criteria made no mention of sexual orientation, and only 69% of participants identified as gay/homosexual. It is unclear from the Results section how the other 31% of participants identified (i.e., queer, bisexual/pansexual, straight/heterosexual, etc.), but at least one participant is described as “straight,” suggesting that not all participants identified as men who have sex with men. Furthermore, although the eligibility criteria for the study included identifying as African American/Black, 2% of participants in the sample did not identify as Black. The researchers should provide a demographics table that clearly describes the gender, sexual orientation, and race/ethnicity of the participants in the sample, and should not describe the sample as “58 HIV-negative Black SMM” if this does not accurately reflect the identities of all participants.

2. Relatedly, it is commendable that the study sample included current PrEP users, PrEP non-users, and PrEP discontinuers, but it would be helpful if a demographics table noted how many participants fell into each category. Additionally, the authors seem to use the phrases “non-PrEP users” and “PrEP Naive Group” interchangeably, but these are not synonymous; one describes participants’ lack of experience taking PrEP, while the other describes participants’ lack of knowledge of PrEP. If all PrEP non-users in the sample were also PrEP naïve, this should be specified within the manuscript.

3. The authors make a strong argument for focusing on Black SMM (because they are disproportionately affected by HIV, and less likely than their white counterparts to receive PrEP prescriptions). Although the introduction references structural inequities that contribute to these health disparities (e.g., racism), the authors may wish to expand their discussion of these systemic/structural factors, and emphasize them over patient-level factors (e.g., likelihood of following providers’ recommendations) that may be seen as blaming patients. Additionally, I would advise the authors to move away from "risk" language throughout the paper, as it can be stigmatizing.

4. The authors organized the findings into two themes, which they defined as “lack of interest in on-demand PrEP” and “high acceptability of LAI-PrEP.” They then identify numerous “reasons” or “common sentiments” expressed by participants. The Results section would benefit from a reorganization that presents these common sentiments as the themes of interest, or as sub-themes under the previously identified umbrella categories. It would also be useful to provide more specific information about the number of participants who expressed each sentiment.

5. According to the Methods section, the focus groups explored “PrEP initiation and adherence, social network composition and influence on PrEP use or lack thereof, and feedback on a planned social network strategy intervention to increase PrEP initiation and adherence among Black SMM.” It is unclear why analyses then exclusively focus on attitudes towards on-demand and LAI-PrEP. Specifically, why did the researchers not discuss attitudes towards daily dosing? Given that daily dosing was mentioned by multiple participants and is the only FDA-approved PrEP schedule, the omission was confusing.

6. The authors provide very interesting illustrative quotations throughout the manuscript, but do not always integrate the quotations into the surrounding text. They may consider including fewer examples within the body of the text, and referencing a table with additional illustrative quotations.

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Reviewer #1: Yes:  Rebecca Giguere

Reviewer #2: No

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Preferences for on-demand/intermittent/event-driven and long-acting injectable (LAI) HIV pre-exposure prophylaxis (PrEP) among HIV-negative Black gay, bisexual, and other sexual minority men in the United States: A qualitative study

PONE-D-24-43968R1

Dear Dr. Ogunbajo,

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Kind regards,

Douglas S. Krakower, MD

Academic Editor

PLOS ONE

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