北京市2871例HIV非职业暴露后预防用药及时性与随访情况分析

Timeliness and follow-up of prophylactic medication in 2,871 cases of nonoccupational HIV exposure in Beijing

目的了解并分析北京市HIV nPEP人群特征,用药及时性与随访依从性及相关因素。方法收集2020-2022北京市某医院HIV暴露后预防门诊就诊者启动nPEP用药和用药后第2、4、12周随访情况;一般人口学、性行为等特征以及nPEP用药方案、既往药物预防服务等情况,采用多因素Logistic回归对nPEP及时性和随访依从性的相关因素进行分析。结果共有2871名就诊者接受nPEP用药服务,其中男性占91.85%(2637人),平均年龄(31.39±8.21)岁。未婚占比70.32%(2019人);大学以上占77.74%(2232人);41.59%(1194人)发生男男同性性行为暴露;发生异性行为占58.41%(1677人),12.33%(354人)发生商业性行为。所有就诊者在用药后第4周HIV检测均阴性。69.28%(1989人)在发生高危行为24 h内及时接受了nPEP用药,多因素分析显示教育程度为大学(OR=2.200,95%CI:1.492~3.252)、大学以上(OR=2.023,95%CI:1.473~2.773)是及时接受nPEP的促进因素,女性(OR=0.573,95%CI:0.422~0.780)、发生商业性行为(OR=0.743,95%CI:0.565~0.980)是及时接受nPEP的阻碍因素。8.67%(249/2871)在启动nPEP用药后完成了全程随访,女性(OR=0.439,95%CI:0.203~0.835)是完成nPEP全程随访的阻碍因素。结论北京市nPEP门诊就诊者以青年男性为主,在女性就诊者中接受nPEP服务及时性和随访依从性仍有提升空间。

Objective To understand and analyze the characteristics of the patients received HIV nonoccupational postexposure prophylaxis(nPEP)in Beijing,including medication timeliness,follow-up compliance,and related factors.Method Data were collected on the initiation of nPEP medication and follow-up at 2,4,and 12 weeks after the administration of medication among patients in the HIV exposure prevention outpatient department of a hospital in Beijing.The study period was from 2020 to 2022.A multiple logistic regression was used to analyze the factors related to the timeliness and follow-up compliance of the nPEP population based on general demographic and sexual behavior characteristics.nPEP medication regimens and past drug prevention services were also examined.Results A total of 2871 patients received nPEP medication services,of which males accounted for 91.85%(2637 people).The average age was 31.39±8.21years.Unmarried individuals accounted for 70.32%(2019 individuals);77.74%(2232 people)had a university degree or above,41.59%(1194 individuals)had been exposed to male homosexual sexual activity,58.41%(1677 individuals)engaged in heterosexual behavior,and 12.33%(354 individuals)engaged in commercial sexual activity.All patients tested negative for HIV during the fourth week of treatment with medication.A total of 69.28%(1989individuals)promptly received nPEP medication within 24 hours of engaging in high-risk behavior.A multivariate analysis showed that a university education level(OR=2.200,95%CI:1.492-3.252)and above(OR=2.023,95%CI:1.473-2.773)were factors promoting the timely acceptance of nPEP,while being female(OR=0.573,95%CI:0.422-0.780)and engaging in commercial sexual activity(OR=0.743,95%CI:0.565-0.980)were hindering factors for the timely acceptance of nPEP.Further,8.67%(249/2871)completed the full follow-up after initiating nPEP medication.However,one's status as a woman(OR=0.439,95%CI:0.203-0.835)appeared to be a barrier to completing the full nPEP follow-up.Conclusions Most n PEP outpatients in Beijing are young males.Improvement in the timeliness and follow-up compliance of n PEP services among female patients is needed.