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Allergic rhinitis is likely the most common medical complaint to a clinical allergist and immunologist affecting between 10 and 30% of all adults. This disease causes significant impact on quality of life as well as creating a financial burden on society with decreased work productivity and medication costs. Often, many allergy sufferers do not adhere to the medication recommendations provided by their physician most often because these therapies have not provided relief. Although in the past, the mainstay of treatment for allergic rhinitis has been environmental avoidance, immunotherapy, nasal corticosteroids, and oral antihistamines, the most recent rhinitis diagnosis parameters published by the American Academy of Allergy, Asthma and Immunology have also discussed the importance of other often overlooked therapies. More specifically, the new guidelines discuss a place for the use of intranasal antihistamines as first-line therapy as well as potentially providing superior relief to second-generation oral antihistamines. The guidelines also identify the biphasic nature of the allergic response with both phases consisting of nasal pruritus, sneezing, rhinorrhea, and congestion with the late phase predominated by nasal congestion. It is important to understand how intranasal antihistamines fit into these latest guidelines as first-line therapy and to understand how they may be beneficial to the symptoms associated with allergic rhinitis. It is equally important to identify the individuals who have had less success with their current therapies to determine if intranasal antihistamines would be an important adjunct in therapy.

Introduction Scaling up pre‐exposure prophylaxis (PrEP) for HIV among men who have sex with men (MSM) and transgender women (TGW) in the Asia‐Pacific region has been slow. We identified the drivers of PrEP use and forecasted PrEP uptake given different PrEP programmes for MSM and TGW living in 15 countries and territories in Asia and Australia. Methods Separate online discrete choice experiment surveys for MSM and TGW were distributed in 15 Asian countries and territories and Australia between May and November 2022. We used random parameters logit models to estimate the relative importance of service attributes and predicted PrEP uptake for different programme configurations. Results Among 21,943 participants included in the MSM survey and 1522 in the TGW survey, the mean age was 31.7 (±9.5) years and 28.1 (±7.0) years, respectively. Cost emerged as the primary driver of PrEP use for MSM and TGW across countries, followed by the type of PrEP. When switching from the least preferred PrEP programme (i.e. very high service fee, PrEP implant, rare kidney problems as side effects of PrEP and a 2‐monthly clinic visit) to an optimal programme (i.e. free access to PrEP via peer‐led community clinics which offered sexually transmitted infection [STI] testing, and a 6–12 monthly visit), the predicted PrEP uptake could improve by over 50% for MSM in Australia, China, Hong Kong SAR China, Japan, the Philippines, Taiwan (China) and Thailand, and 37% for TGW. Compared to those at lower risk of HIV, free access was more preferred by MSM at a higher risk of HIV, while telehealth was more preferred by TGW at a substantial risk of HIV. Conclusions Tailoring services to local contexts, including ensuring affordability, preferred type of PrEP and providing differentiated services, could accelerate the uptake of PrEP among MSM and TGW in Asia and Australia. Novel innovations, such as STI and HIV self‐testing, should be explored as alternatives to conventional testing, given that most MSM and TGW prefer less frequent clinic visits and long‐acting PrEP options.

Introduction Despite the high HIV incidence among gay, bisexual and other men who have sex with men (GBMSM) and the demonstrated effectiveness of HIV pre‐exposure prophylaxis (PrEP), PrEP is not accessible at scale across Asia. To help inform future scaling efforts, our study aimed to examine PrEP use and willingness to use among GBMSM to identify opportunities and target groups for upscaling PrEP. Methods The PrEP APPEAL survey was a cross‐sectional survey, promoted through online advertising and community organizations, from May to November 2022. Eligible participants were adult GBMSM who self‐identified as HIV negative residing in Asia. We constructed two cascades: PrEP use (comprising awareness, lifetime use and current use of PrEP) and PrEP willingness among participants who were aware of PrEP but had never used it (comprising HIV exposure risk, willingness in PrEP and willingness to pay for PrEP). Multivariable logistic regression models identified factors associated with lifetime PrEP use and PrEP willingness. Results Of 15,339 participants, 1440 were excluded due to missing data, leaving 13,899 for analysis. Most lived in large or capital cities (68.3%) and in lower‐middle‐income countries (45.1%). The median age was 30 (25−36) years old. For the PrEP use cascade, 82.2% (n = 11,427/13,899) of participants were aware of PrEP, 35.0% (n = 4000/11,427) had used it before and 70.1% (n = 2803/4000) of them were currently on PrEP. For the PrEP willingness cascade, 54.8% of (n = 4068/7427) PrEP‐naïve participants engaged in one or more behaviours with a higher risk of HIV acquisition, 73.7% (n = 2996/4068) of them expressed willingness to use PrEP and 83.0% (n = 2487/2996) of them were willing to pay for PrEP. Multivariable logistic regression models identified system‐level (PrEP availability, accessibility and affordability) predictors of PrEP use. Individual‐level behaviours associated with higher HIV acquisition risks were associated with PrEP use and willingness. Conclusions While PrEP uptake was suboptimal, there was high awareness and willingness in PrEP among GBMSM. This is encouraging for future scale‐up efforts. Future PrEP programmes should address system‐level barriers to support PrEP uptake.

Pre-exposure prophylaxis (PrEP) use could be accelerated by offering alternatives that overcome key barriers associated with oral PrEP. This study aimed to understand willingness and preferences for long-acting injectable cabotegravir (CAB-LA) among gay men and other men who have sex with men (MSM), and transgender women (TGW) in Asia. An online cross-sectional survey was conducted from May to November 2022 among HIV-negative or unknown status MSM and TGW aged ≥18 years across 15 and 11 Asian countries/territories, respectively. Survey items included awareness and use of PrEP and CAB-LA, willingness to use current and emerging PrEP options, and attitudes towards CAB-LA. Descriptive statistics and logistic regression were used to analyse associations with willingness to use CAB-LA. Among 11,870 MSM and 980 TGW, 21.4% (n = 2448) and 32.5% (n = 295) were aware of CAB-LA, respectively, and 17.2% (n = 2036) and 16.8% (n = 165) were willing to use it. CAB-LA was the most preferred PrEP option for 3.6% (n = 400) of MSM and 6.5% (n = 61) of TGW. Awareness and willingness varied across countries/territories and populations. Key benefits of CAB-LA included HIV protection (57.8% MSM, 46.8% TGW), no need for daily pills (42.6% MSM, 31.1% TGW) and longer-term protection (38.0% MSM, 23.6% TGW). Main concerns included cost (39.6% MSM, 22.1% TGW), side-effects (37.5% MSM, 22.2% TGW), insufficient knowledge (33.3% MSM, 20.6% TGW) and pain (21.4% MSM, 24.9% TGW). Successful introduction of CAB-LA, or other new long-acting injectable PrEP options, in Asia will require strategies to raise awareness and demand-generation that responds to the perceived benefits and concerns of communities.

Background The Philippines has witnessed a 550% increase in HIV cases between 2010 and 2023, disproportionately affecting men who have sex with men (MSM). Despite the national rollout of pre-exposure prophylaxis (PrEP) in 2021, uptake remains limited, with structural and individual barriers, such as PrEP-associated cost and stigma influencing engagement. This study explores Filipino MSM's preferences for PrEP service attributes to inform person-centered HIV prevention strategies. Methods A cross-sectional online survey, as part of the PrEP APPEAL multicountry study, was conducted among MSM in the Philippines in May to November 2022. A discrete choice experiment embedded in the survey assessed preferences for six PrEP service attributes, including type, access location, cost, side-effects, visit frequency and additional services. Preferences were analyzed using random parameters logit and latent class models. Results Among 2282 MSM respondents (mean age=28.8years, s.d.=7.9), 68.9% had heard of PrEP, yet only 18.3% were current users. In the pooled analysis, cost, PrEP type, and side-effects were the most influential attributes. MSM preferred free oral PrEP but willing to pay up to Philippine Peso (PHP) 1000 (AUD 25) per month (β =0.06, P =0.032), services accessed through community-led clinics (β =0.12, P =0.001), and yearly clinic visits (β =0.14, P Conclusions Despite growing awareness, uptake among Filipino MSM remains limited. Findings highlight diverse user preferences, reinforcing the need for differentiated, person-centered PrEP models. Expanding community-based access, ensuring affordability and integrating user-informed features can optimize uptake, whereas sustainable financing and phased rollout of newer modalities are essential for national scale-up.

Background Pre-exposure prophylaxis (PrEP) uptake remains low in mainland China and Hong Kong. We examined preferences for different PrEP modalities among men who have sex with men (MSM) in mainland China and Hong Kong. Methods We conducted a cross-sectional online survey from May to November 2022 in mainland China and Hong Kong. Eligible participants were aged ≥18years, identified as MSM and self-reported HIV-negative, or unknown HIV status. Random forest models and SHapley Additive exPlanations analyses were used to identify key factors influencing preferences for and willingness to use six PrEP options: (1) daily oral, (2) on-demand oral, (3) monthly oral, (4) two-monthly injectable, (5) six-monthly injectable, and (6) implantable PrEP. Results Among 2142 participants (mainland China: 1604; Hong Kong: 538), the mean age was 28.4 (±7.0) years in mainland China and 34.7 (±9.5) years in Hong Kong. Current PrEP use was similar between mainland China and Hong Kong (18.0% vs 17.8%, P =0.93), with an additional 10.5% and 8.0% reporting past PrEP use (P =0.11), respectively. A greater proportion of participants from mainland China preferred on-demand PrEP compared to those from Hong Kong (55.7% vs 48.1%, P P =0.02). Willingness to use non-oral options was lower, with two-monthly injectable PrEP preferred by 21.1% (19.1-23.1%) in mainland China and 15.4% (12.3-18.5%) in Hong Kong (P Conclusions On-demand and monthly PrEP options remain the preferred choices, though the monthly oral option is neither proven nor available. However, the factors influencing these preferences vary, highlighting the need for tailored and targeted approaches to PrEP implementation.