School of Public Health, Sun Yat-Sen University, Guangzhou, China.
School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China.
AIDS Patient Care STDS. 2020 May;34(5):193-204. doi: 10.1089/apc.2019.0313.
HIV nonoccupational postexposure prophylaxis (nPEP) has been prescribed to men who have sex with men (MSM) for decades, but the global situation of nPEP implementation among this population remains unclear. To understand nPEP awareness, uptake, and factors associated with uptake among MSM, we searched PubMed, Scopus, Embase, the Cochrane Library, and Web of Science for studies reporting nPEP implementation among MSM published before May 19, 2019. We estimated pooled rates and their 95% confidence intervals (CIs) of awareness, uptake using a random-effects model. We identified 74 studies: 3 studies (4.1%) from upper-middle-income regions and 71 (95.9%) from high-income regions. The pooled rate of nPEP awareness and uptake was 51.6% (95% CI 40.6-62.5%) and 6.0% (5.0-7.1%), respectively. Pooled uptake rate was higher in upper-middle-income regions [8.9% (7.8-10.0%)] than in high-income regions [5.8% (4.8-6.9%)]. Unprotected anal sex was the most common exposure (range: 55.0-98.6%, median: 62.9%). Pooled completion of nPEP was 86.9% (79.5-92.8%). Of 19,546 MSM prescribed nPEP, 500 HIV seroconversions (2.6%) were observed. Having risky sexual behaviors and history of sexually transmitted infections were associated with higher nPEP uptake, whereas insufficient knowledge, underestimated risk of exposure to HIV, lack of accessibility, and social stigma might hinder nPEP uptake. Awareness and uptake of nPEP among MSM worldwide are low. Further efforts are needed to combat barriers to access nPEP, including improving accessibility and reducing stigma. Seroconversions post-nPEP uptake suggest that joint prevention precautions aside from nPEP are needed for high-risk MSM. More evidence from low-income and middle-income regions is needed.
几十年来，艾滋病毒非职业接触后预防（nPEP）已被开给男男性行为者（MSM），但全球 MSM 人群中 nPEP 的实施情况仍不清楚。为了了解 MSM 人群中 nPEP 的知晓率、使用率以及与使用率相关的因素，我们检索了 PubMed、Scopus、Embase、Cochrane 图书馆和 Web of Science，以获取截至 2019 年 5 月 19 日发表的有关 MSM 中 nPEP 实施情况的研究。我们使用随机效应模型估算了知晓率、使用率的汇总率及其 95%置信区间（CI）。我们共识别到 74 项研究：3 项（4.1%）来自中高收入地区，71 项（95.9%）来自高收入地区。nPEP 知晓率和使用率的汇总率分别为 51.6%（95%CI 40.6-62.5%）和 6.0%（5.0-7.1%）。中高收入地区的 nPEP 使用率[8.9%（7.8-10.0%）]高于高收入地区[5.8%（4.8-6.9%）]。无保护肛交是最常见的暴露途径（范围：55.0-98.6%，中位数：62.9%）。nPEP 完成率汇总为 86.9%（79.5-92.8%）。在 19546 名接受 nPEP 治疗的 MSM 中，观察到 500 例 HIV 血清转换（2.6%）。有风险性行为和性传播感染史与更高的 nPEP 使用率相关，而知识不足、低估 HIV 暴露风险、无法获得 nPEP 和社会污名化可能会阻碍 nPEP 的使用。全球 MSM 中 nPEP 的知晓率和使用率均较低。需要进一步努力来克服获取 nPEP 的障碍，包括提高可及性和减少污名化。nPEP 使用率后的血清转换表明，高危 MSM 除了 nPEP 之外，还需要联合预防措施。需要更多来自低收入和中等收入地区的证据。
