Peng Peng, Su Shu, Fairley Christopher K, Chu Minjie, Jiang Shengyang, Zhuang Xun, Zhang Lei
School of Public Health, Nantong University, 9 Seyuan Road, Nantong, Jiangsu, 226019, China.
School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
AIDS Behav. 2018 Apr;22(4):1063-1074. doi: 10.1007/s10461-017-1675-z.
Pre-exposure prophylaxis (PrEP) is a new biomedical intervention for HIV prevention. This study systematically reviews the acceptability of PrEP among men who have sex with men (MSM) worldwide. We searched major English databases to identify English-language articles published between July 2007 and July 2016, which reported the acceptability of PrEP and associated population characteristics. Meta-analysis was conducted to estimate a pooled acceptability, and meta-regression and subgroup analysis were used to analyse heterogeneities. The estimated acceptance from included sixty-eight articles was 57.8% (95% confidence internal 52.4-63.1%). MSM who were younger (4/5 studies, range of adjusted odds ratio (aOR) = 1.39-3.47), better educated (aOR = 1.49-7.70), wealthier (aOR = 1.31-13.03) and previously aware of PrEP (aOR = 1.33-3.30) showed significantly higher acceptance. Male sex workers (84.0% [26.3-98.7%] were more likely to accept PrEP than general MSM. Self-perceived low efficacy, concern about side effects, adherence, affordability, and stigma were main barriers. This review identifies a moderate acceptability of PrEP in MSM. Efficacy, perception of HIV risk and experienced stigma determine its acceptance.
暴露前预防（PrEP）是一种预防艾滋病毒的新型生物医学干预措施。本研究系统评价了全球男男性行为者（MSM）对PrEP的接受程度。我们检索了主要英文数据库，以识别2007年7月至2016年7月期间发表的英文文章，这些文章报告了PrEP的可接受性及相关人群特征。进行荟萃分析以估计合并可接受性，并采用荟萃回归和亚组分析来分析异质性。纳入的68篇文章估计的接受率为57.8%（95%置信区间52.4-63.1%）。年龄较小（4/5项研究，调整优势比（aOR）范围=1.39-3.47）、受教育程度较高（aOR=1.49-7.70）、较富裕（aOR=1.31-13.03）且之前知晓PrEP（aOR=1.33-3.30）的男男性行为者显示出显著更高的接受率。男男性工作者（84.0%[26.3-98.7%]）比一般男男性行为者更有可能接受PrEP。自我感知的低疗效、对副作用、依从性、可承受性和耻辱感的担忧是主要障碍。本综述确定了男男性行为者对PrEP的中等接受程度。疗效、对艾滋病毒风险的认知和经历的耻辱感决定了其接受程度。
