停止使用HIV暴露前预防（PrEP）后的使用障碍及性行为：德国的一项横断面研究
Barriers to using HIV pre-exposure prophylaxis (PrEP) and sexual behaviour after stopping PrEP: a cross-sectional study in Germany.
作者信息
Koppe Uwe, Marcus Ulrich, Albrecht Stefan, Jansen Klaus, Jessen Heiko, Gunsenheimer-Bartmeyer Barbara, Bremer Viviane
机构信息
Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
出版信息
BMC Public Health. 2021 Jan 19;21(1):159. doi: 10.1186/s12889-021-10174-4.
BACKGROUND
Persistence of individuals at risk of HIV with Pre-Exposure Prophylaxis (PrEP) is critical for its impact on the HIV epidemic. We analysed factors associated with stopping PrEP, barriers that may deter people from continuing PrEP and investigated sexual behaviour after stopping PrEP.
METHODS
Current and former PrEP users in Germany were recruited to complete an anonymous online survey on PrEP use and sexual behaviour. Participants were recruited through dating apps, a PrEP community website, anonymous testing sites and peers. The results were analysed using descriptive methods and logistic regression.
RESULTS
We recruited 4848 current and 609 former PrEP users in two study waves (July-October 2018, April-June 2019). Former PrEP users were more likely 18-29 years old than current users (adjusted OR = 1.6, 95% confidence interval (CI) 1.1-2.3). Moreover, they were more often unhappy with their sex life, which was more pronounced in former daily PrEP users (aOR = 4.5, 95% CI 2.9-7.1) compared to former on-demand users (aOR = 1.8, 95% CI 1.1-2.9, p = 0.005). The most common reason for stopping PrEP was a reduced need for PrEP (49.1%). However, 31.4% of former users identified logistic reasons and 17.5% stopped due to side effects. Former PrEP users using PrEP < 3 months were more likely to stop PrEP due to concerns over long-term side effects (32.0% vs. 22.5%, p = 0.015) and not wanting to take a chemical substance (33.2% vs. 24.0%, p = 0.020) compared to former PrEP users who used PrEP for longer. After stopping PrEP, 18.7% of former PrEP users indicated inconsistent condom use while having ≥4 sex partners within the previous 6 months. Former PrEP users with many partners and inconsistent condom use more often indicated logistic reasons for stopping (46.5% vs. 27.9%, p < 0.001) than did other former PrEP users.
CONCLUSIONS
To maximise persistence with PrEP we need to develop strategies for younger PrEP users, reduce logistic barriers to access PrEP, and to develop effective communication on side-effect management. Moreover, prevention strategies for people stopping PrEP are required, since some remain at high risk for HIV.
背景
艾滋病病毒暴露前预防（PrEP）高危个体坚持使用PrEP对于其对艾滋病流行的影响至关重要。我们分析了与停止使用PrEP相关的因素、可能阻碍人们继续使用PrEP的障碍，并调查了停止使用PrEP后的性行为。
方法
招募德国目前和曾经使用PrEP的用户，以完成一项关于PrEP使用和性行为的匿名在线调查。通过约会应用程序、一个PrEP社区网站、匿名检测站点和同伴招募参与者。使用描述性方法和逻辑回归分析结果。
结果
在两个研究阶段（2018年7月至10月、2019年4月至6月），我们招募了4848名目前使用PrEP的用户和609名曾经使用PrEP的用户。曾经使用PrEP的用户比目前使用PrEP的用户更可能年龄在18 - 29岁（调整后的比值比[OR]=1.6，95%置信区间[CI] 1.1 - 2.3）。此外，他们对性生活更不满意，这在曾经每日使用PrEP的用户中比曾经按需使用PrEP的用户更为明显（调整后的OR = 4.5，95% CI 2.9 - 7.1）（调整后的OR = 1.8，95% CI 1.1 - 2.9，p = 0.005）。停止使用PrEP最常见的原因是对PrEP的需求减少（49.1%）。然而，31.4%的曾经使用PrEP的用户指出是后勤方面的原因，17.5%的用户因副作用而停止使用。与使用PrEP时间较长的曾经使用PrEP的用户相比，使用PrEP < 3个月的曾经使用PrEP的用户更可能因对长期副作用的担忧（32.0%对22.5%，p = 0.015）和不想服用化学物质（33.2%对24.0%，p = 0.020）而停止使用PrEP。停止使用PrEP后，18.7%的曾经使用PrEP的用户表示在过去6个月内与≥4个性伴侣发生性行为时避孕套使用不一致。有多个性伴侣且避孕套使用不一致的曾经使用PrEP的用户比其他曾经使用PrEP的用户更常指出后勤方面的原因导致停止使用（46.5%对27.9%，p < 0.001）。
结论
为了最大限度地提高PrEP的坚持率，我们需要为年轻的PrEP用户制定策略，减少获取PrEP的后勤障碍，并开展关于副作用管理的有效沟通。此外，需要针对停止使用PrEP的人群制定预防策略，因为一些人仍处于感染艾滋病病毒的高风险中。
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