Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
The Kirby Institute, University of New South Wales, Sydney, Australia.
J Med Internet Res. 2021 Dec 23;23(12):e33877. doi: 10.2196/33877.
BACKGROUND: New innovative technologies, such as mobile apps, have been developed to increase pre-exposure prophylaxis (PrEP) adherence and the use of log sex diaries. The contiguity of mobile apps reduces the recall bias that generally affects reported condom and PrEP use. However, none of the currently used mobile apps were designed for event-driven PrEP users, and few studies have demonstrated the potential usage of sex diary data to facilitate the understanding of the different HIV risks among heterogeneous profiles of sex diaries and PrEP use. OBJECTIVE: We aim to discriminate the heterogeneous profiles of sex events and PrEP use and examine the risk of condomless anal sex among different types of sex events. METHODS: We recruited 35 adult men who have sex with men from two medical centers in Taiwan since May 2020 and followed up for four months. Participants were on PrEP or willing to take PrEP. They were asked to log their sex events, PrEP use, and dosing regimens on a mobile app to improve their PrEP adherence. Latent class analysis was used to distinguish profiles of sex events and PrEP use. Indicators included correct intake of PrEP for each sex event, participants' sexual positioning, partner's HIV status, and age. RESULTS: A total of 551 sex events were classified into three classes by latent class analysis: PrEP nonadherent flip-flopping (234/551, 42%), PrEP imperfect-adherent power bottoming (284/551, 52%), and PrEP adherent serodiscordant topping (33/551, 6%). "PrEP nonadherent flip-flopping" sex events were more likely to involve condomless anal sex than "PrEP imperfect-adherent power bottoming" (OR 1.83, 95% CI 1.03-3.25) after considering random intercepts for individuals, and this class needed to increase their PrEP adherence and use of condoms. "PrEP imperfect-adherent power bottoming" realized their own risk and packaged PrEP with condoms to protect themselves. Up to 99% (32/33) of sex events in "PrEP adherent serodiscordant topping" were protected by PrEP, but all of the sex events in this group were condomless. CONCLUSIONS: Using the sex diary data could advance the capacity to identify high-risk groups. HIV prevention strategy should be more flexible and combine PrEP with condom use for future HIV prevention.
背景：为了提高暴露前预防（PrEP）的依从性和日志式性行为的使用，新的创新技术，如移动应用程序，已经被开发出来。移动应用程序的连续性减少了通常影响报告的避孕套和 PrEP 使用的回忆偏差。然而，目前使用的移动应用程序中没有一个是专为事件驱动的 PrEP 用户设计的，而且很少有研究表明性行为日志数据的潜在用途可以帮助理解不同 HIV 风险在不同类型的性行为和 PrEP 使用中的差异。
目的：我们旨在区分性行为和 PrEP 使用的异质模式，并检查不同类型的性行为中无保护肛交的风险。
方法：我们从 2020 年 5 月起在台湾的两家医疗中心招募了 35 名男男性行为者，并进行了四个月的随访。参与者正在服用 PrEP 或愿意服用 PrEP。他们被要求在移动应用程序上记录他们的性行为、PrEP 的使用和剂量方案，以提高他们的 PrEP 依从性。潜在类别分析用于区分性行为和 PrEP 使用的模式。指标包括每次性行为正确服用 PrEP、参与者的性体位、伴侣的 HIV 状态和年龄。
结果：通过潜在类别分析，共将 551 次性行为分为三类：PrEP 非依从性反复无常（234/551，42%）、PrEP 不完全依从性有力性底（284/551，52%）和 PrEP 依从性血清不一致性上位（33/551，6%）。考虑到个体的随机截距后，“PrEP 非依从性反复无常”性行为比“PrEP 不完全依从性有力性底”性行为更有可能涉及无保护肛交（OR 1.83，95%CI 1.03-3.25），因此该类人群需要提高他们的 PrEP 依从性并使用避孕套。“PrEP 不完全依从性有力性底”意识到了自己的风险，并将 PrEP 与避孕套一起包装，以保护自己。在“PrEP 依从性血清不一致性上位”中，高达 99%（32/33）的性行为都受到 PrEP 的保护，但该组的所有性行为都没有使用避孕套。
结论：使用性行为日志数据可以提高识别高风险群体的能力。未来的 HIV 预防策略应该更加灵活，将 PrEP 与避孕套的使用结合起来。
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