[Needs of pre-exposure prophylaxis for HIV infection and related barriers among men who have sex with men].
[Needs of pre-exposure prophylaxis for HIV infection and related barriers among men who have sex with men].
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DOI：
10.3760/cma.j.issn.0254-6450.2020.03.012
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发表时间：
2020-03-10
影响因子：
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通讯作者：
Zhang, H B
中科院分区：
文献类型：
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作者：
Shi, A X;Operario, D;Zhang, H B
目的：了解男男性行为者（MSM）对艾滋病病毒感染暴露前预防（PrEP）的实际需求及影响PrEP使用的因素。方法：采用MSM社交应用软件Blued6.5.0，通过MSM同伴推荐招募被试，样本量为600人。通过“问卷星星”平台，在研究者的指导下进行匿名电子问卷调查。调查内容包括调查对象的人口学特征、对PrEP相关知识的知晓情况、使用PrEP的意愿和顾虑、PrEP的实际需求以及使用PrEP的自我效能。结果：共调查622名MSM，其中56.4%（351/622）的MSM听说过PrEP，4.3%（27/622）的MSM使用过PrEP。PrEP需求评估显示，67.2%（418/622）的参与者对PrEP有实际需求，21.2%（132/622）的参与者使用PrEP时自我效能良好。结构方程模型分析显示，MSM对PrEP相关知识的知晓程度和对PrEP使用的关注程度对PrEP使用的自我效能有直接的正向作用，效应系数分别为0.08和0.13。MSM的自我歧视通过对PrEP使用的担忧间接影响PrEP使用的自我效率，影响系数为0.035。广义线性混合模型分析结果显示，使用PrEP可提高使用PrEP的自我效能（OR=5.55），对PrEP相关知识的知晓度和对PrEP使用的关注度每增加1分，使用PrEP的自我效能分别增加0.14倍和0.07倍。此外，本次调查发现，参与者对使用PrEP的主要担忧是副作用、HIV预防效果和费用，分别占61.1%（380/622）、60.1%（374/622）和53.2%（331/622）。希望从疾控中心、MSM社会组织和互联网获得PrEP服务的比例最高，分别为75.6%（470/622）、65.4%（407/622）和63.8%（397/622）。结论：MSM对PrEP服务的需求高，利用低。PrEP相关知识知晓率低、担心PrEP的预防效果、副作用、费用以及自我歧视是影响MSM使用PrEP的因素。因此，有必要建立一个适合MSM人群的PrEP服务模式，以满足MSM人群对PrEP的需求。
Objective: To understand the actual needs for the pre-exposure prophylaxis (PrEP) for HIV infection and the factors hindering PrEP utilization in men who have sex with men (MSM). Methods: Participants were recruited by using MSM social application software Blued 6.5.0 and through MSM peer referral, sample size was 600. An electronic questionnaire survey was conducted anonymously with guidance of investigators via "Questionnaire Star" platform. The contents of the survey included demographic characteristics of the participants, the awareness of PrEP related knowledge, willingness and concerns about using PrEP, actual need for PrEP and self-efficacy of using PrEP. Results: A total of 622 MSM completed the survey, of whom 56.4% (351/622) and 4.3% (27/622) ever heard of and received PrEP, respectively. The need assessment of PrEP showed that 67.2% (418/622) of the participants had actual needs for PrEP and 21.2% (132/622) used PrEP with good self-efficacy. Structural equation modeling analysis showed that the awareness of PrEP related knowledge and concerning about PrEP utilization in MSM played a direct positive role in their self-efficiency of using PrEP, and the effect coefficients were 0.08 and 0.13, respectively. MSM self-discrimination indirectly affected the self-efficiency of using PrEP through concerns about PrEP use, the effect coefficient was 0.035. The result of generalized linear mixed model analysis demonstrated that the utilization of PrEP can improve the self-efficacy of using PrEP (OR=5.55), which increased by 0.14 times and 0.07 times with the increase of 1 score of the awareness of PrEP related knowledge and concern about using PrEP respectively. In addition, this survey found that in the participants, the main concerns about using PrEP were side effects, HIV prevention effect and its expense, accounting for 61.1% (380/622), 60.1% (374/622) and 53.2% (331/622), respectively. Most participants hoped to obtain PrEP services from CDC, MSM social organization and internet, accounting for 75.6% (470/622), 65.4% (407/622), and 63.8% (397/622), respectively. Conclusions: MSM showed difference of high need but low utilization of PrEP services. Low awareness of PrEP related knowledge, concerns about the prevention effect, side effects and expense of PrEP as well as self-discrimination were the factors hindering the use of PrEP in MSM. It is necessary to establish a suitable PrEP service model to meet the needs for PrEP in MSM.