基于结构方程模型的大学生男男性行为者HIV暴露后预防药物使用情况及相关因素研究

Post-exposure prophylaxis(PEP)usage and related factors among college MSM based on structural equation modeling

目的分析大学生MSM PEP药物使用情况及相关因素,为今后PEP的推广工作提供依据。方法在杭州、宁波、嘉兴、金华等4市招募年龄在18岁以上的曾发生过男男性行为的大学生为研究对象。采用非概率抽样法,由当地社会组织开展招募和问卷调查,采用面对面或电话调查的方式开展信息收集,内容包括社会人口学特征、艾滋病防治知识、危险性行为、HIV检测、安全套使用效能和PEP药物使用等信息。采用SPSS 25.0软件进行探索性因子分析,采用AMOS 23.0进行结构方程模型构建,分析各变量间的关系及影响程度。结果共调查671名大学生MSM,PEP报告用药率为9.1%(61/671)。修正后的结构方程模型拟合较好,χ^(2)/df=1.43,RMSEA=0.03,增值适配度指标均大于0.9的参考值范围,简约适配度指标均大于0.5的参考值范围。模型拟合结果显示知识来源途径对MSM学生PEP药物使用的影响作用最大,其次是网络临时性行为、HIV检测、安全套使用效能、艾滋病防治知识,总效应值分别为-0.25、0.15、0.15、-0.08、0.01。结论艾滋病防治知识、网络临时性行为、HIV检测、知识来源途径、安全套使用效能等对大学生MSM暴露后预防用药产生一定效应,应加强PEP知识的宣传,让有暴露风险的MSM能及时使用PEP。

Objective To analyze the use of post-exposure prophylaxis(PEP)medication among university men who have sex with men(MSM)and explore related factors,providing a basis for future PEP promotion efforts.Methods College MSM aged 18 years and above from four cities(Hangzhou,Ningbo,Jiaxing,and Jinhua)were recruited as participants.Non-probability sampling was employed,and local community organizations were recruited and administered the surveys.Data were collected through face-to-face or telephone interviews regarding sociodemographic characteristics,HIV/AIDS prevention knowledge,risky sexual behaviors,HIV testing,condom use efficacy,and PEP medication use.An exploratory factor analysis was conducted using SPSS 25.0,and structural equation modeling(SEM)was performed using AMOS 23.0 to analyze the relationships and influences between variables.Results A total of 671 college MSM were surveyed,with a PEP usage rate of 9.1%(61/671).The adjusted SEM model exhibited a good fit,withχ^(2)/df=1.43,RMSEA=0.03,and all incremental and parsimonious fit indices exceeding reference values(>0.9 and>0.5,respectively).Model results indicated that information sources exerted the greatest influence on PEP usage among MSM students,followed by online casual sexual encounters,HIV testing,condom use efficacy,and HIV/AIDS prevention knowledge,with total effect values of-0.25,0.15,0.15,-0.08,and 0.01,respectively.Conclusions HIV/AIDS prevention knowledge,casual online sexual encounters,HIV testing,information sources,and condom use efficacy all influence PEP usage among college MSM to varying degrees.Enhancing the dissemination of PEP knowledge is essential to ensure that MSM at risk of exposure can access PEP in a timely manner.