Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, PR China.
School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, PR China.
J Int AIDS Soc. 2022 Mar;25(3):e25883. doi: 10.1002/jia2.25883.
Integrated knowledge regarding pre-exposure prophylaxis (PrEP) awareness and willingness to use PrEP can be useful for HIV prevention in high incidence groups. This review summarizes the awareness of PrEP and willingness to use PrEP among men who have sex with men (MSM).
Online electronic databases were searched before 31 August 2021. A meta-analysis was conducted to pool studies analysing PrEP awareness and willingness to use PrEP. LOESS regression and linear regression were applied to fit the trends over time for the proportion of MSM aware of PrEP and willing to use PrEP. Dose-response meta-analysis (DRMA) was conducted by a restricted cubic spline model to explore the relationship between willingness to use PrEP and selected factors.
A total of 156 articles involving 228,403 MSM were included. The pooled proportions of MSM aware of PrEP and willing to use PrEP were 50.0 (95% CI: 44.8-55.2) and 58.6% (95% CI: 54.8-62.4), respectively. PrEP awareness varied among countries with different economic status and different WHO regions, among different publication and research years, PrEP types and support policies. PrEP willingness differed among countries with different economic status and groups with different risks of HIV. The awareness of PrEP increased from 2007 to 2019 with a slope of 0.040260 (p<0.0001), while the proportion of MSM willing to use PrEP decreased from 2007 to 2014 (slope = -0.03647, p = 0.00390) but increased after 2014 (slope = 0.04187, p = 0.03895). The main facilitators of willingness to use PrEP were PrEP awareness, condomless sexual behaviours, high perceived risk of HIV infection and influence of social network. The main barriers were doubts about the efficacy and side effects of PrEP. DRMA results indicated that MSM with more sexual partners and lower level of education were more willing to use PrEP. No publication bias was observed.
The proportions of PrEP awareness and willingness to use PrEP among MSM have increased since 2014, although the awareness was low and the willingness was moderate. Improving awareness of PrEP through increasing access to PrEP-related health education and enhancing risk perceptions of HIV infection could have positive effects on the willingness to use PrEP among MSM.
综合了解暴露前预防（PrEP）的认知和使用意愿，有助于在高感染率人群中预防 HIV。本综述总结了男男性行为者（MSM）对 PrEP 的认知和使用意愿。
在线电子数据库检索截至 2021 年 8 月 31 日的数据。对分析 PrEP 认知和使用意愿的研究进行荟萃分析。应用 LOESS 回归和线性回归拟合 MSM 对 PrEP 的认知和使用意愿的比例随时间的变化趋势。采用受限立方样条模型进行剂量-反应荟萃分析（DRMA），以探讨使用 PrEP 的意愿与选定因素之间的关系。
共纳入 156 篇文章，涉及 228403 名 MSM。MSM 对 PrEP 的认知和使用意愿的合并比例分别为 50.0%（95%CI：44.8-55.2）和 58.6%（95%CI：54.8-62.4）。PrEP 认知在不同经济状况的国家和不同世界卫生组织地区、不同出版和研究年份、不同 PrEP 类型和支持政策之间存在差异。使用 PrEP 的意愿在不同经济状况的国家和不同 HIV 风险的群体之间存在差异。从 2007 年到 2019 年，PrEP 的认知呈上升趋势，斜率为 0.040260（p<0.0001），而 MSM 使用 PrEP 的意愿从 2007 年到 2014 年呈下降趋势（斜率=-0.03647，p=0.00390），但 2014 年后呈上升趋势（斜率=0.04187，p=0.03895）。使用 PrEP 的意愿的主要促进因素是 PrEP 认知、无保护性行为、HIV 感染的高感知风险和社交网络的影响。主要障碍是对 PrEP 的疗效和副作用的怀疑。DRMA 结果表明，性伴侣较多和教育程度较低的 MSM 更愿意使用 PrEP。未观察到发表偏倚。
自 2014 年以来，MSM 对 PrEP 的认知和使用意愿有所增加，尽管认知水平较低，意愿水平中等。通过增加 PrEP 相关健康教育的可及性和增强对 HIV 感染风险的认知，提高对 PrEP 的认知，可能对 MSM 使用 PrEP 的意愿产生积极影响。
