Factors Associated With Willingness to Use Pre-Exposure Prophylaxis in Brazil, Mexico, and Peru: Web-Based Survey Among Men Who Have Sex With Men
Factors Associated With Willingness to Use Pre-Exposure Prophylaxis in Brazil, Mexico, and Peru: Web-Based Survey Among Men Who Have Sex With Men
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DOI：
10.2196/13771
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发表时间：
2019-04-01
影响因子：
8.5
通讯作者：
Veloso, Valdilea G.
中科院分区：
文献类型：
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作者：
Torres, Thiago Silva;Konda, Kelika A.;Veloso, Valdilea G.
背景：艾滋病毒不成比例地影响关键人群，包括男男性行为者（MSM）。男男性行为者的艾滋病毒流行率从巴西和墨西哥的17%到秘鲁的13%不等，而每个国家的一般人口的艾滋病毒流行率都低于0.5%。在联合预防艾滋病毒的背景下，正在实施恩曲他滨/替诺福韦暴露前预防（PrEP）。在过去几年中，关于男男性接触者中使用PrEP的意愿的报告已经开始出现。先前报道的与使用PrEP的意愿相关的因素包括意识、更高的性风险行为和以前的性传播感染。目的：本研究旨在评估三个拉丁美洲中等收入国家（巴西、墨西哥和秘鲁）的男男性行为者每日口服PrEP的相关因素。方法：这项基于网络的横断面调查是在2018年的两个月里，在男同性恋者用来寻找性伴侣的两个同性恋社交网络应用程序（Grindr和Hornet）和Facebook上做广告的。纳入标准为18岁及以上、顺性别男性、自我报告hiv阴性。符合条件的个人回答了有关人口统计、行为和PrEP（意识、使用意愿、障碍和促进因素）的问题。采用多变量logistic回归模型来评估每个国家与每日口服PrEP的使用意愿相关的因素。结果：在43,687人的总样本中，44.54%的MSM（19,457/43,687）符合条件并完成了基于网络的调查——巴西：58.42%(11,367/19,457)，墨西哥：30.50%(5934/19,457)，秘鲁：11.08% (2156/19,457)；中位年龄为28岁（四分位数范围：24-34岁），几乎一半的人生活在大城市。大多数参与者是在Grindr上招募的（69%,13,349/19,457）。近20%的人（3862/ 19352）从未进行过艾滋病毒检测，在过去6个月内，有40%的人（7755/ 19326）报告无安全套肛交。67.51%（13,110/19,376）的参与者有资格进行PrEP，只有9.80%（1858/18,959）的参与者有高艾滋病毒风险认知。PrEP知晓率为64.92% (12,592/19,396)；秘鲁的这一比例较低（46.60%,2002 /2156）。总体而言，报告使用PrEP的意愿为64.23% (12,498/19,457)；墨西哥最高（70%,4158/5934），秘鲁最低（58%,1241/2156）。在对每个国家的年龄、学校教育和收入进行调整的多变量回归模型中，使用PrEP的意愿与PrEP意识和PrEP辅助工具（如免费PrEP和艾滋病毒检测）呈正相关，与行为障碍（如关注每日服药方案）和信念障碍（如性伴侣可能期望无安全套性行为）负相关。结论：在拉丁美洲进行的首次基于网络的跨国调查中，发现使用PrEP的意愿很高，并且与PrEP意识直接相关。提高对PrEP安全性和有效性的认识和知识的干预措施对于增加PrEP需求至关重要。本研究为支持在巴西、墨西哥和秘鲁实施PrEP提供了重要信息。
Background: HIV disproportionally affects key populations including men who have sex with men (MSM). HIV prevalence among MSM varies from 17% in Brazil and Mexico to 13% in Peru, whereas it is below 0.5% for the general population in each country. Pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir is being implemented in the context of combination HIV prevention. Reports on willingness to use PrEP among MSM have started to emerge over the last few years. Previously reported factors associated with willingness to use PrEP include awareness, higher sexual risk behavior, and previous sexually transmitted infection.Objective: This study aimed to evaluate the factors associated with willingness to use daily oral PrEP among MSM in 3 Latin American, middle-income countries (Brazil, Mexico, and Peru).Methods: This Web-based, cross-sectional survey was advertised in 2 gay social network apps (Grindr and Hornet) used by MSM to find sexual partners and on Facebook during 2 months in 2018. Inclusion criteria were being 18 years or older, cisgender men, and HIV-negative by self-report. Eligible individuals answered questions on demographics, behavior, and PrEP (awareness, willingness to use, barriers, and facilitators). Multivariable logistic regression modeling was performed to assess the factors associated with willingness to use daily oral PrEP in each country.Results: From a total sample of 43,687 individuals, 44.54% of MSM (19,457/43,687) were eligible and completed the Web-based survey-Brazil: 58.42% (11,367/19,457), Mexico: 30.50% (5934/19,457), and Peru: 11.08% (2156/19,457); median age was 28 years (interquartile range: 24-34), and almost half lived in large urban cities. Most participants were recruited on Grindr (69%, 13,349/19,457). Almost 20% (3862/19,352) had never tested for HIV, and condomless receptive anal sex was reported by 40% (7755/19,326) in the previous 6 months. Whereas 67.51% (13,110/19,376) would be eligible for PrEP, only 9.80% (1858/18,959) of participants had high HIV risk perception. PrEP awareness was reported by 64.92% (12,592/19,396); this was lower in Peru (46.60%, 1002/2156). Overall, willingness to use PrEP was reported by 64.23% (12,498/19,457); it was highest in Mexico (70%, 4158/5934) and lowest in Peru (58%, 1241/2156). In multivariate regression models adjusted for age, schooling, and income in each country, willingness to use PrEP was positively associated with PrEP awareness and PrEP facilitators (eg, free PrEP and HIV testing) and negatively associated with behavioral (eg, concerned by daily pill regimen) and belief barriers (eg, sexual partners may expect condomless sex).Conclusions: In this first cross-country, Web-based survey in Latin America, willingness to use PrEP was found to be high and directly related to PrEP awareness. Interventions to increase awareness and PrEP knowledge about safety and efficacy are crucial to increase PrEP demand. This study provides important information to support the implementation of PrEP in Brazil, Mexico, and Peru.