School of Nursing, College of Medicine, National Taiwan University, Taipei City, Taiwan.
Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
JMIR Public Health Surveill. 2023 Feb 16;9:e43394. doi: 10.2196/43394.
BACKGROUND: Mobile voluntary counseling and testing (VCT) for HIV has been carried out to improve the targeting of at-risk populations and HIV case detection for men who have sex with men (MSM). However, the HIV-positive detection rate using this screening strategy has declined in recent years. This may imply unknown changes in risk-taking and protective features jointly influencing the testing results. These changing patterns in this key population remain unexplored. OBJECTIVE: The aim of this study was to identify the nuanced group classification of MSM who underwent mobile VCT using latent class analysis (LCA), and to compare the difference in characteristics and testing results between subgroups. METHODS: A cross-sectional research design and purposive sampling were applied between May 21, 2019, and December 31, 2019. Participants were recruited by a well-trained research assistant through social networking platforms, including the most popular instant messenger app Line, geosocial network apps dedicated to MSM, and online communities. Mobile VCT was provided to participants at an assigned time and place. Demographic characteristics and risk-taking and protective features of the MSM were collected via online questionnaires. LCA was used to identify discrete subgroups based on four risk-taking indicators-multiple sexual partners (MSP), unprotected anal intercourse (UAI), recreational drug use within the past 3 months, and history of sexually transmitted diseases-and three protective indicators-experience of postexposure prophylaxis, preexposure prophylaxis use, and regular HIV testing. RESULTS: Overall, 1018 participants (mean age 30.17, SD 7.29 years) were included. A three-class model provided the best fit. Classes 1, 2, and 3 corresponded to the highest risk (n=175, 17.19%), highest protection (n=121, 11.89%), and low risk and low protection (n=722, 70.92%), respectively. Compared to those of class 3, class 1 participants were more likely to have MSP and UAI within the past 3 months, to be ≥40 years of age (odds ratio [OR] 2.197, 95% CI 1.357-3.558; P=.001), to have HIV-positive results (OR 6.47, 95% CI 2.272-18.482; P<.001), and a CD4 count ≤349/μL (OR 17.50, 95% CI 1.223-250.357; P=.04). Class 2 participants were more likely to adopt biomedical preventions and have marital experience (OR 2.55, 95% CI 1.033-6.277; P=.04). CONCLUSIONS: LCA helped derive a classification of risk-taking and protection subgroups among MSM who underwent mobile VCT. These results may inform policies for simplifying the prescreening assessment and more precisely recognizing those who have higher probabilities of risk-taking features but remain undiagnosed targets, including MSM engaging in MSP and UAI within the past 3 months and those ≥40 years old. These results could be applied to tailor HIV prevention and testing programs.
背景:为了提高高危人群的针对性和艾滋病病毒病例的检出率,已经开展了移动自愿咨询和检测(VCT)服务。然而,近年来,使用这种筛查策略的艾滋病病毒阳性检出率有所下降。这可能意味着共同影响检测结果的风险行为和保护特征发生了未知的变化。该关键人群的这些变化模式仍有待探索。
目的:本研究旨在通过潜在类别分析(LCA)确定接受移动 VCT 的男男性行为者(MSM)的细微分组分类,并比较亚组之间特征和检测结果的差异。
方法:2019 年 5 月 21 日至 12 月 31 日期间采用横断面研究设计和目的性抽样。通过经验丰富的研究助理通过社交网络平台(包括最受欢迎的即时通讯应用 Line、专门面向 MSM 的地理社交网络应用程序和在线社区)招募参与者。在指定的时间和地点为参与者提供移动 VCT。通过在线问卷收集 MSM 的人口统计学特征和风险行为及保护特征。基于四个风险行为指标(多个性伴侣(MSP)、无保护肛交(UAI)、过去 3 个月内使用娱乐性药物和性传播疾病史)和三个保护指标(接触后预防经验、暴露前预防使用和定期艾滋病病毒检测),采用潜在类别分析(LCA)来识别离散亚组。
结果:共有 1018 名参与者(平均年龄 30.17 岁,SD 7.29 岁)被纳入研究。三阶模型提供了最佳拟合。类别 1、2 和 3 分别对应于最高风险(n=175,17.19%)、最高保护(n=121,11.89%)和低风险低保护(n=722,70.92%)。与类别 3 相比,类别 1 的参与者更有可能在过去 3 个月内有多个性伴侣和无保护肛交行为,年龄≥40 岁(比值比[OR]2.197,95%置信区间[CI]1.357-3.558;P=.001),HIV 阳性结果(OR 6.47,95%CI 2.272-18.482;P<.001)和 CD4 计数≤349/μL(OR 17.50,95%CI 1.223-250.357;P=.04)。类别 2 的参与者更有可能采用生物医学预防措施和有婚姻经历(OR 2.55,95%CI 1.033-6.277;P=.04)。
结论:潜在类别分析有助于对接受移动 VCT 的 MSM 中的风险行为和保护亚组进行分类。这些结果可以为简化预筛查评估提供信息,并更准确地识别那些具有较高风险行为特征但仍未被诊断出的目标人群,包括过去 3 个月内有多个性伴侣和无保护肛交行为以及年龄≥40 岁的 MSM。这些结果可以应用于制定艾滋病病毒预防和检测方案。
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