Liu Jiaxiu, Deng Ruibin, Lin Bing, Pan Hong, Gao Yuwen, Dai Jianghong, Liang Hao, Huang Ailong, Zhong Xiaoni
School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, People's Republic of China.
School of Medical Information, Chongqing Medical University, Chongqing, People's Republic of China.
Risk Manag Healthc Policy. 2021 Apr 28;14:1749-1761. doi: 10.2147/RMHP.S295114. eCollection 2021.
Men who have sex with multiple men (MSMM) belong to a high-risk group for HIV infection, and pre-exposure prophylaxis (PrEP) is an effective measure to prevent the infection. However, few studies on PrEP adherence by MSMM in China exist. We aimed to explore the protective motivation-related factors for PrEP adherence in an HIV-negative MSMM population in Western China and to provide a reference for future risk management and effective prevention strategies.
Data were collected from a 2-year follow-up cohort study of PrEP in MSM in China. Rogers' protective motivation theory (PMT) was used to study the PrEP adherence of MSMM, and logistic regression was performed to analyze the influencing factors of PrEP adherence.
A total of 496 MSMM were included in the study: 299 (60.28%) of them in the good adherence group and 197 (39.72%) in the poor adherence group. The threat assessment scores of the good and poor adherence groups were 2.15 ± 0.59 and 2.06 ± 0.47, respectively, and the response assessment scores were 2.81 ± 0.62 and 2.74 ±0.62, respectively. Poor PrEP adherence was associated with on-demand PrEP medication (OR=0.670), students at school (OR=1.837), occasional condom use (OR=1.621), and good HIV knowledge (OR= 0.659). The higher the threat assessment score, the higher the susceptibility; and the lower the response cost, the stronger the protection motivation and the less likely MSMM were to have poor adherence.
On-demand PrEP medication is more conducive to adherence. Preventive management should focus on MSMMs who are students at school, those who occasionally use condoms, and those with poor HIV knowledge. Improving threat perception and susceptibility, and controlling and reducing the response cost can effectively improve PrEP adherence, and the subsequent application of PMT during intervention research can provide a reference for HIV prevention in MSMM.
与多名男性发生性行为的男性（MSMM）属于HIV感染的高危人群，暴露前预防（PrEP）是预防感染的有效措施。然而，中国关于MSMM对PrEP依从性的研究较少。我们旨在探讨中国西部HIV阴性MSMM人群中与PrEP依从性相关的保护动机因素，为未来的风险管理和有效预防策略提供参考。
数据来自中国男男性行为者PrEP的一项为期2年的随访队列研究。采用罗杰斯的保护动机理论（PMT）研究MSMM对PrEP的依从性，并进行逻辑回归分析PrEP依从性的影响因素。
本研究共纳入496名MSMM：其中299名（60.28%）为依从性良好组，197名（39.72%）为依从性较差组。依从性良好组和较差组的威胁评估得分分别为2.15±0.59和2.06±0.47，反应评估得分分别为2.81±0.62和2.74±0.62。PrEP依从性差与按需服用PrEP药物（OR=0.670）、在校学生（OR=1.837）、偶尔使用避孕套（OR=1.621）以及HIV知识良好（OR=0.659）有关。威胁评估得分越高，易感性越高；反应成本越低，保护动机越强，MSMM依从性差的可能性越小。
按需服用PrEP药物更有利于依从性。预防管理应关注在校学生、偶尔使用避孕套以及HIV知识较差的MSMM。提高威胁感知和易感性，控制和降低反应成本可有效提高PrEP依从性，干预研究中后续应用PMT可为MSMM的HIV预防提供参考。
