我国24个城市男男性行为者HIV暴露前预防用药现状及相关因素分析

Status and associated factors of pre-exposure prophylaxis use among men who have sex with men in 24 cities in China

目的了解我国MSM对HIV暴露前预防(PrEP)的认知和用药现状及影响因素。方法2021年8月25日至9月5日通过男性社交平台Blued 7.5软件在我国24个城市招募MSM 2447人参与线上问卷调查,调查内容包括社会人口学、PrEP知晓和用药与高危性行为等信息。采用三分类二水平logistic回归分析MSM的PrEP用药相关因素。采用SPSS 24.0和SAS 9.4软件进行统计学分析。结果在MSM研究对象2447人中,听说过PrEP者1712人(69.96%),曾用药者437人(17.86%),正在用药者274人(11.20%),停用者163人(6.66%);437人曾用药者多数采用了按需用药方式,用药方案采用替诺福韦+恩曲他滨的占61.88%(388/627),人均用量为1.12片/周,获取药物以互联网为主,选择药物更关注PrEP用药的预防效果;163人停药最常见原因是认为没有HIV感染的风险。logistic回归分析结果显示,MSM中PrEP用药与年龄、月均收入、最近1年发生无保护肛交、最近1年使用助性剂和被诊断出患有性病等因素存在统计学关联,其中,与18~24岁组相比,25~44岁组的PrEP药物停用(aOR=0.54,95%CI:0.34~0.87)和未用药物(aOR=0.62,95%CI:0.44~0.87)的比例均较低。正在PrEP用药组的最近1年发生无保护肛交的比例均高于PrEP停用组和未用过组(均P<0.05);未用过PrEP组的月均收入≥5000元、最近1年使用助性剂和被诊断患有性病的比例较低(均P<0.05)。结论我国MSM中PrEP用药主要通过互联网获取并以按需用药方式服用。尽管用药者达到一定比例,但仍需针对PrEP效果、副作用等内容加强健康教育,提升知晓率和用药率,建议在年轻MSM中利用互联网优势关注其PrEP用药需求和用药障碍。

Objective To understand the cognition and medication use of pre-exposure prophylaxis(PrEP)among men who have sex with men(MSM)in China and its associated factors.Method From August 25 to September 5,2021,2447 MSM were recruited in 24 cities to complete the online questionnaire through a male social interaction platform,Blued 7.5 software.The survey contents included demographic information of the respondents,PrEP awareness and usage,and risk behaviors.Descriptive analysis and multi-level logistic regression were performed for data analysis.SPSS 24.0 and SAS 9.4 software were used for statistical analysis.Results Among the 2447 respondents of MSM,1712(69.96%)had heard of PrEP,437(17.86%)ever used PrEP,274(11.20%)were on PrEP,and 163(6.66%)had discontinued PrEP;among the 437 cases(whoever used PrEP),more than 61.88%(388/627)adopted emtricitabine/tenofovir disoproxil fumarate regimen,and most of them adopted on-demand regimen.The average PrEP dosage reported in the past year is 1.12 tabletsper person per week.PrEP purchase was primarily via an online channel,and the most concerned factor was the PrEP effectiveness on HIV prevention.The most common reasons for discontinuing PrEP,reported by 163 cases,were the lack of HIV risk perception,the use of a condom to prevent HIV,and the economic burden of PrEP use.The logistic regression analysis showed that PrEP use among MSM in 24 cities was statistically associated with age,monthly income,ever having unprotected anal sex in the past year,used sexual drugs and sexually transmitted disease(STD)diagnosis in the past year.Compared with MSM aged 18-24,the proportion of MSM was relatively lower among those aged 25-44,who discontinued the PrEP(aOR=0.54,95%CI:0.34-0.87)or never used PrEP(aOR=0.62,95%CI:0.44-0.87).The proportion of unprotected anal sex among MSM currently on PrEP use was higher than those who have stopped PrEP and never used PrEP(all P<0.05).Those MSM group,with monthly income higher than 5000 Yuan,used sexual drugs and STD diagnosis in the past year were more likely to have a higher rate for PrEP usage(all P<0.05).Conclusions Currently,pre-exposure prophylaxis in the MSM group is primarily obtained via the online channel and adopted in an on-demand mode.Although the PrEP users have reached a certain proportion,it is still necessary to strengthen health education on the PrEP effects and side effects of MSM and to improve the awareness and use rate,especially for young MSM group,which can be combined with the advantages of the internet targeting its needs and use barriers.