Changes in mental health and drug use among men who have sex with men using daily and event-driven pre-exposure prophylaxis: Results from a prospective demonstration project in Amsterdam, the Netherlands.
Changes in mental health and drug use among men who have sex with men using daily and event-driven pre-exposure prophylaxis: Results from a prospective demonstration project in Amsterdam, the Netherlands.
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DOI：
10.1016/j.eclinm.2020.100505
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发表时间：
2020-09
影响因子：
15.1
通讯作者：
de Vries HJC
中科院分区：
文献类型：
--
作者：
Achterbergh RCA;Hoornenborg E;Boyd A;Coyer L;Meuzelaar SJA;Hogewoning AA;Davidovich U;van Rooijen MS;Schim van der Loeff MF;Prins M;de Vries HJC
同性恋、双性恋和其他男男性行为者（GBMSM）患精神疾病和吸毒的风险增加。在GBMSM采取暴露前预防（PrEP）的艾滋病毒，从事危险行为的比例可能会增加，由于减少艾滋病毒的风险感知。反过来，这可能会使他们更容易患上心理健康疾病。AMPrEP研究（AMPrEP）是一个示范项目，在阿姆斯特丹公共卫生服务的STI诊所提供每日PrEP或事件驱动的PrEP方案的选择。合格的参与者是HIV阴性GBMSM和有HIV风险的变性人，年龄≥18岁。我们使用年度自我评估（2015年8月至2018年9月）评估了焦虑和抑郁情绪障碍（精神健康量表5），性强迫（性强迫量表），酒精使用障碍（酒精使用障碍识别测试）和药物使用障碍（药物使用障碍识别测试）。分析了心理健康问题的比例，并使用逻辑回归模型评估了随时间和方案之间的变化。使用多状态马尔可夫模型评估与疾病发展或恢复相关的变量。在376名入组者中，我们分析了341名参与者的基线数据和至少一次随访数据。在2.5年的中位随访期间（IQR=2.3-2.7），性强迫的比例从基线时的23%下降到末次访视时的10%（p<0.001），药物使用障碍从基线时的38%下降到末次访视时的31%（p = 0.004）。焦虑/抑郁情绪障碍（基线时为20%，末次访视时为18%，p = 0.358）或酒精使用障碍（基线时为28%，末次访视时为22%，p = 0.106）的评估比例未发生变化。在随访期间，参与者报告使用酒精（p<0.001），亚硝酸盐（p<0.001）和摇头丸（p<0.001）的情况明显减少。我们发现日常和事件驱动的PrEP用户之间没有差异。随访期间疾病的发展和恢复高度相关。心理健康障碍在那些启动PrEP的人中普遍存在。我们没有发现PrEP使用期间心理健康障碍的增加，而是性强迫和药物使用障碍的减少。在我们的研究中，心理健康障碍的最初患病率表明，持续需要在PrEP计划中解决心理健康障碍问题。ZonMw、H-TEAM、内部GGD研究基金、Aidsfonds、Stichting AmsterdamDiner Foundation、吉利德科学、杨森制药、M A C艾滋病基金和ViiV Healthcare。
Gay, bisexual and other men who have sex with men (GBMSM) are at increased risk of mental health disorders and drug use. In GBMSM taking pre-exposure prophylaxis (PrEP) for HIV, the proportion engaging in risk behaviors could increase due to decreased perception in HIV risk. In turn, this could leave them further susceptible to mental health disorders. The AMsterdam PrEP study (AMPrEP) is a demonstration project offering a choice of daily PrEP or event-driven PrEP regimen at the STI clinic of the Public Health Service of Amsterdam. Eligible participants were HIV-negative GBMSM and transgender people at risk of HIV, aged ≥18 years. We assessed anxiety and depressive mood disorders (Mental Health Inventory 5), sexual compulsivity (Sexual Compulsivity Scale), alcohol use disorder (Alcohol Use Disorder Identification Test), and drug use disorder (Drug Use Disorder Identification Test) using yearly self-administered assessments (August 2015–September 2018). The proportion of mental health problems were analyzed and changes over time and between regimen were assessed using a logistic regression model. Variables associated with the development or recovery of disorders were assessed using a multistate Markov model. Of 376 enrolled, we analyzed 341 participants with data at baseline and at least one follow-up visit. During a median follow-up of 2.5 years (IQR=2.3–2.7), the proportion assessed with sexual compulsivity decreased from 23% at baseline to 10% at the last visit (p<0.001) and drug use disorder decreased from 38% at baseline to 31% at the last visit (p = 0.004). No changes occurred in proportion assessed with anxiety/depressive mood disorders (20% at baseline, 18% at last visit, p = 0.358) or alcohol use disorder (28% at baseline, 22% at the last visit, p = 0.106). During follow-up, participants reported significant less use of alcohol (p<0.001), nitrites (p<0.001) and ecstasy (p<0.001). We found no differences between daily and event-driven PrEP users. The development and recovery of disorders during follow-up were highly interrelated. Mental health disorders are prevalent among those initiating PrEP. We did not find increases in mental health disorders during PrEP use, but rather a decrease in sexual compulsivity and drug use disorders. The initial prevalence of mental health disorders in our study point at the continuous need to address mental health disorders within PrEP programs. ZonMw, H-TEAM, Internal GGD research funds, Aidsfonds, Stichting AmsterdamDiner Foundation, Gilead Sciences, Janssen Pharmaceutica, M A C AIDS Fund, and ViiV Healthcare.
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影响因子：
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