山东省男男性行为人群HIV暴露前后预防用药情况及相关因素分析

Acceptance of pre-exposure prophylaxis and post-exposure prophylaxis against HIV and related factors in men who have sex with men in Shandong Province

目的了解山东省MSM的HIV暴露前后预防(PrEP/PEP)用药情况并分析相关因素,为PrEP/PEP工作的推广提供参考依据。方法 2022年4-7月在山东省7个城市监测哨点招募MSM进行问卷调查,每个城市样本量为400人。收集MSM社会人口学、性行为、PrEP/PEP用药等信息,并采集血标本做HIV和梅毒抗体检测。结果研究对象MSM共2 815人,以≤30岁(55.7%,1 569/2 815)、未婚(68.6%,1 931/2 815)、大专及以上文化程度(56.5%,1 590/2 815)为主。PrEP用药者占9.2%(258/2 815);PEP用药者占10.8%(305/2 815)。多因素logistic回归分析结果显示,MSM中PrEP用药的可能性较高的相关因素包括年龄≤30岁(aOR=4.04,95%CI:1.25~13.01)、自我认知HIV感染风险较低(aOR=1.76,95%CI:1.16~2.68)、最近6个月发生群交行为(aOR=1.51,95%CI:1.10~2.09)、最近6个月发生同性商业性行为(aOR=1.69,95%CI:1.16~2.47)、使用新型毒品(aOR=1.53,95%CI:1.11~2.11)、接受同伴教育(aOR=1.56,95%CI:1.03~2.37)、知晓别人PrEP用药(aOR=3.29,95%CI:2.48~4.36)、HIV抗体阴性(aOR=8.40,95%CI:1.12~63.12);MSM中PrEP用药的可能性较低的相关因素为主要性伴为临时性伴(aOR=0.67,95%CI:0.49~0.90)。MSM中PEP用药的可能性较高的相关因素包括年龄<50岁(≤30岁:aOR=2.41,95%CI:1.02~5.69;31~49岁:aOR=3.33,95%CI:1.42~7.85)、自我认知无HIV感染风险(aOR=1.87,95%CI:1.12~3.11)、最近6个月发生群交行为(aOR=1.68,95%CI:1.23~2.29)、使用新型毒品(aOR=3.86,95%CI:2.94~5.07)以及未接受同伴教育(aOR=1.54,95%CI:1.12~2.12)。结论山东省MSM的PrEP/PEP用药比例较高。应加强同伴教育和自我认知HIV风险教育,提高MSM中PrEP/PEP用药的使用率。

Objectives To understand the use of pre-exposure prophylaxis(PrEP)and post-exposure prophylaxis(PEP)and related factors in men who have sex with men(MSM)in Shandong Province,and provide reference for the promotion of PrEP and PEP in MSM.Methods From April to July in 2022,MSM were recruited from 7 sentinel surveillance sites in Shandong Province for a questionnaire survey,and the sample size of each city site was 400.The information about sociodemographic characteristics,sexual behaviors,the uses of PrEP and PEP and others were collected from the MSM,and blood samples were collected from them for HIV and syphilis testing.Results A total of 2815 MSM were investigated,the majority of them were aged less than 30 years(55.7%,1569/2815),unmarried(68.6%,1931/2815)and had education background of college and above(56.5%,1590/2815).Only 9.2%(258/2815)had used PrEP and 10.8%(305/2815)had used PEP.Multivariate logistic regression showed that factors associated with high likelihood of PrEP use in MSM included age≤30 years(aOR=4.04,95%CI:1.25-13.01),self-perceived lower risk of HIV infection(aOR=1.76,95%CI:1.16-2.68),group sex and commercial sex in the past six months(aOR=1.51,95%CI:1.10-2.09;aOR=1.69,95%CI:1.16-2.47),new-type drug use(aOR=1.53,95%CI:1.11-2.11),receiving peer education(aOR=1.56,95%CI:1.03-2.37),other people using PrEP(aOR=3.29,95%CI:2.48-4.36),and being HIV negative(aOR=8.40,95%CI:1.12-63.12).Factor associated with low likelihood of PrEP use in MSM was anal sex with casual partner(aOR=0.67,95%CI:0.49-0.90).Factors associated with high likelihood of PEP use in MSM included age under 50 years(≤30 years old:aOR=2.41,95%CI:1.02-5.69;31-49 years old:aOR=3.33,95%CI:1.42-7.85),no self-perceived risk for HIV infection(aOR=1.87,95%CI:1.12-3.11),group sex in the past six months(aOR=1.68,95%CI:1.23-2.29),new-type drug use(aOR=3.86,95%CI:2.94-5.07)and receiving no peer education(aOR=1.54,95%CI:1.12-2.12).Conclusions In Shandong,a higher proportion of MSM used PrEP and PEP.Peer education and self-perceived HIV infection risk education should be strengthened to increase the rates of PrEP and PEP use in MSM.