加拿大城市男同性恋、双性恋和其他男男性行为者中 HIV 暴露前预防的使用：Engage 队列研究的横断面分析。
Use of HIV pre-exposure prophylaxis among urban Canadian gay, bisexual and other men who have sex with men: a cross-sectional analysis of the Engage cohort study.
机构信息
Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que.
出版信息
CMAJ Open. 2021 May 21;9(2):E529-E538. doi: 10.9778/cmajo.20200198. Print 2021 Apr-Jun.
BACKGROUND
In Canada, gay, bisexual and other men who have sex with men (GBM) are disproportionately affected by HIV. Our objective was to describe access to HIV pre-exposure prophylaxis (PrEP) and identify factors associated with not using PrEP among self-reported HIV-negative or HIV-unknown GBM.
METHODS
This was a cross-sectional analysis of the Engage study cohort. Between 2017 and 2019, sexually active GBM aged 16 years or more in Montréal, Toronto and Vancouver were recruited via respondent-driven sampling (RDS). Participation included testing for HIV and sexually transmitted and blood-borne infections, and completion of a questionnaire. We examined PrEP access using a health care services model and fit RDS-adjusted logistic regressions to determine correlates of not using PrEP among those for whom PrEP was clinically recommended and who were aware of the intervention.
RESULTS
A total of 2449 GBM were recruited, of whom 2008 were HIV-negative or HIV-unknown; 1159 (511 in Montréal, 247 in Toronto and 401 in Vancouver) met clinical recommendations for PrEP. Of the 1159, 1100 were aware of PrEP (RDS-adjusted proportion: Montréal 84.6%, Toronto 94.2%, Vancouver 92.7%), 678 had felt the need for PrEP in the previous 6 months (RDS-adjusted proportion: Montréal 39.2%, Toronto 56.1%, Vancouver 49.0%), 406 had tried to access PrEP in the previous 6 months (RDS-adjusted proportion: Montréal 20.6%, Toronto 33.2%, Vancouver 29.6%) and 319 had used PrEP in the previous 6 months (RDS-adjusted proportion: Montréal 14.5%, Toronto 21.6%, Vancouver 21.8%). Not using PrEP was associated with several factors, including not feeling at high enough risk, viewing PrEP as not completely effective, not having a primary care provider and lacking medication insurance.
INTERPRETATION
Although half of GBM met clinical recommendations for PrEP, less than a quarter of them reported use. Despite high levels of awareness, a programmatic response that addresses PrEP-related perceptions and health care system barriers is needed to scale up PrEP access among GBM in Canada.
背景
在加拿大，男同性恋、双性恋和其他与男性发生性关系的男性（GBM）受到艾滋病毒的影响不成比例。我们的目的是描述获得艾滋病毒暴露前预防（PrEP）的情况，并确定自我报告 HIV 阴性或 HIV 未知的 GBM 中不使用 PrEP 的相关因素。
方法
这是一项对 Engage 研究队列的横断面分析。在 2017 年至 2019 年期间，蒙特利尔、多伦多和温哥华的年龄在 16 岁及以上的活跃 GBM 通过响应驱动抽样（RDS）招募。参与包括艾滋病毒和性传播及血液传播感染的检测，以及完成一份问卷。我们使用医疗保健服务模型检查 PrEP 的获取情况，并拟合 RDS 调整的逻辑回归模型，以确定在临床推荐使用 PrEP 且知晓干预措施的人群中不使用 PrEP 的相关因素。
结果
共招募了 2449 名 GBM，其中 2008 名 HIV 阴性或 HIV 未知；1159 名（蒙特利尔 511 名，多伦多 247 名，温哥华 401 名）符合 PrEP 的临床推荐。在 1159 名中，1100 名知晓 PrEP（RDS 调整比例：蒙特利尔 84.6%，多伦多 94.2%，温哥华 92.7%），678 名在过去 6 个月内感到需要 PrEP（RDS 调整比例：蒙特利尔 39.2%，多伦多 56.1%，温哥华 49.0%），406 名在过去 6 个月内试图获得 PrEP（RDS 调整比例：蒙特利尔 20.6%，多伦多 33.2%，温哥华 29.6%），319 名在过去 6 个月内使用过 PrEP（RDS 调整比例：蒙特利尔 14.5%，多伦多 21.6%，温哥华 21.8%）。不使用 PrEP 与多种因素相关，包括感觉风险不够高、认为 PrEP 不完全有效、没有初级保健提供者和缺乏药物保险。
解释
尽管一半的 GBM 符合 PrEP 的临床推荐，但只有不到四分之一的人报告使用。尽管知晓率很高，但需要采取一项以解决与 PrEP 相关的认知和医疗保健系统障碍的方案性措施，以扩大加拿大 GBM 中 PrEP 的获取。
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