Walmsley Ben, Gallant Dan, Naccarato Mark, Hull Mark, Smith Alex, Tan Darrell Hoi-San
Division of Infectious Diseases, St Michael's Hospital, Toronto, ON, Canada.
Gay Men's Sexual Health Alliance, Toronto, ON, Canada.
J Med Internet Res. 2019 Jul 22;21(7):e12076. doi: 10.2196/12076.
In response to the high cost of HIV pre-exposure prophylaxis (PrEP) medications in Canada, community organizations have created internet-based guides detailing how to legally order generic medications online and travel to collect them in the United States. However, little is known about the patients following these guides.
Our primary objective was to measure the proportion of Ontario gay, bisexual, and other men who have sex with men (GBMSM) accessing these online guides who intended to use the border-crossing approach. Our secondary objectives were to explore their demographic characteristics, their completion of the steps in the border-crossing approach, and the barriers they perceived.
Between July 20, 2017, and May 18, 2018, we administered two online surveys of GBMSM accessing an online border-crossing guide posted by a gay men's health organization in Ontario. Participants completed an open baseline survey posted on the border-crossing guide's Web page and a follow-up survey 3 months later. The data were analyzed using descriptive statistics. We used multivariable logistic regression to identify characteristics associated with the intention to use the border-crossing approach.
Most of the 141 participants were young (median age 23, interquartile range 22-25 years) and black (79.4%; 112/141) GBMSM who had completed a college or an undergraduate degree (62.4%; 88/141). In addition, 19.9% (28/141) of them reported a total family income less than Can $30,000 and another 53.9% (76/141) reported income between Can $30,000 and Can $60,000. 54.6% (76/141) paid for medications entirely out of pocket. Most participants indicated that they were likely to complete a border-crossing approach: 80.1% (113/141) at baseline and 79.1% (87/110) at follow-up. The characteristics associated with the intention to use the approach included being black (adjusted odds ratio [aOR] 5.73, 95% CI 2.06-16.61), paying for medications out of pocket (aOR 5.18, 95% CI 1.82-17.04), and having a provider who was thought to be willing to prescribe PrEP (aOR 4.42, 95% CI 1.63-12.41). Comparing baseline and follow-up for the 110 participants who completed both surveys, 65.4% (72/110) and 80.0% (88/110) had discussed PrEP with a health care provider, 18.1% (20/110) and 25.4% (28/110) had obtained a PrEP prescription, and 8.2% (9/110) and 5.5% (6/110) had ordered medications to that mailbox, whereas only 1.0% (1/110) and 0.0% (0/110) had crossed the border to collect them at baseline and follow-up, respectively. Reported barriers included perceived concerns about the approach's legality (56.0%; 79/141), the security of personal health information (39.0%; 55/141), and the safety of online vendors (38.3%; 54/141).
Despite high interest in pursuing an online border-crossing approach to get PrEP medications, such an approach may not be a viable option for PrEP scale-up among interested GBMSM because of logistical challenges and perceptions of safety and legitimacy.
为应对加拿大艾滋病毒暴露前预防（PrEP）药物的高昂成本，社区组织创建了基于互联网的指南，详细说明如何合法地在线订购仿制药并前往美国领取。然而，对于遵循这些指南的患者了解甚少。
我们的主要目标是衡量安大略省男同性恋者、双性恋者和其他与男性发生性行为的男性（GBMSM）中访问这些在线指南并打算采用过境方式的比例。我们的次要目标是探索他们的人口统计学特征、他们完成过境步骤的情况以及他们所感知到的障碍。
在2017年7月20日至2018年5月18日期间，我们对访问安大略省一个男同性恋健康组织发布的在线过境指南的GBMSM进行了两次在线调查。参与者完成了发布在过境指南网页上的开放式基线调查以及3个月后的随访调查。数据采用描述性统计进行分析。我们使用多变量逻辑回归来确定与采用过境方式意图相关的特征。
141名参与者中的大多数是年轻（中位年龄23岁，四分位间距22 - 25岁）且为黑人（79.4%；112/141）的GBMSM，他们已完成大专或本科学历（62.4%；88/141）。此外，19.9%（28/141）的人报告家庭总收入低于30,000加元，另有53.9%（76/141）报告收入在30,000加元至60,000加元之间。54.6%（76/141）的人完全自掏腰包支付药物费用。大多数参与者表示他们可能会完成过境方式：基线时为80.1%（113/141），随访时为79.1%（87/110）。与采用该方式意图相关的特征包括为黑人（调整后的优势比[aOR] 5.73，95%置信区间2.06 - 16.61）、自掏腰包支付药物费用（aOR 5.18，95%置信区间1.82 - 17.04）以及有一位被认为愿意开具PrEP处方的医疗服务提供者（aOR 4.42，95%置信区间1.63 - 12.41）。对完成两次调查的110名参与者的基线和随访情况进行比较，65.4%（72/110）和80.0%（88/110）的人与医疗服务提供者讨论过PrEP，18.1%（20/110）和25.4%（28/110）的人获得了PrEP处方，8.2%（9/110）和5.5%（6/110）的人向该邮箱订购了药物，而在基线和随访时分别只有1.0%（1/110）和0.0%（0/110）的人过境去领取药物。报告的障碍包括对该方式合法性的担忧（56.0%；79/141）、个人健康信息的安全性（39.0%；55/141）以及在线供应商的安全性（38.3%；54/141）。
尽管对采用在线过境方式获取PrEP药物兴趣浓厚，但由于后勤挑战以及对安全性和合法性的担忧，这种方式对于感兴趣的GBMSM扩大PrEP规模可能不是一个可行的选择。
