Huang Yiting, Tian Runmeng, Zhou Ziwei, Xu Jiyao, Agins Bruce, Zou Huachun, Chen Qiaosen, Sun Zhishan, Zhong Qingguang, Ma Ziyan, Jiang Hongbo
Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China.
Division of Epidemiology, HEALTHQUAL, Institute for Global Health Sciences, University of California, San Francisco, California, USA.
AIDS Patient Care STDS. 2023 Apr;37(4):159-191. doi: 10.1089/apc.2022.0198.
Knowledge of the proportion of Pre-Exposure Prophylaxis (PrEP) use among men who have sex with men (MSM) and the specific gaps in PrEP use can stimulate enhanced focus on HIV prevention policies and programs. To summarize the proportion of PrEP use and explore the temporal trend in the proportion of PrEP use and factors associated with PrEP use among MSM on a global scale, we searched PubMed, Embase, Web of Science Core Collection, and APA PsycINFO for studies reporting on the use of HIV PrEP among MSM before April 2022. Freeman-Tukey double arc-sine transformation and random-effects models were used to pool estimates. A total of 147 articles involving 395,218 MSM were included. The pooled proportions of PrEP use among MSM and PrEP-eligible MSM were 11.23% [95% confidence interval (CI): 9.71-12.84] and 16.04% (95% CI: 11.99-23.36), respectively. The proportion of PrEP use varied among countries with different support policies. β regressions with the logit link showed that the proportion of PrEP use has increased in recent years. Interrupted time series analyses further supported that the approval of PrEP use would decrease the number of new HIV diagnoses among MSM. The main factors associated with PrEP use include health insurance, having a regular medical provider, prior HIV testing, past use of PrEP or Post-Exposure Prophylaxis, social networks, and stigma. Although the proportion of PrEP use among MSM has remained low, it has increased in recent years. More studies are needed to explore the factors associated with PrEP use, especially for PrEP-eligible MSM in low- and middle-income countries.
了解男男性行为者（MSM）中暴露前预防（PrEP）的使用比例以及PrEP使用中的具体差距，可促使人们更加关注艾滋病病毒预防政策和项目。为了总结PrEP的使用比例，探讨全球范围内MSM中PrEP使用比例的时间趋势以及与PrEP使用相关的因素，我们在PubMed、Embase、科学网核心合集和美国心理学会心理学文摘数据库中检索了2022年4月之前报告MSM使用艾滋病病毒PrEP情况的研究。采用弗里曼-图基双反正弦变换和随机效应模型汇总估计值。共纳入147篇文章，涉及395,218名MSM。MSM和符合PrEP使用条件的MSM中PrEP使用的汇总比例分别为11.23%[95%置信区间（CI）：9.71 - 12.84]和16.04%（95%CI：11.99 - 23.36）。在有不同支持政策的国家中，PrEP的使用比例各不相同。采用对数链接的β回归显示，近年来PrEP的使用比例有所增加。中断时间序列分析进一步支持，PrEP使用的获批将减少MSM中新发艾滋病病毒诊断病例的数量。与PrEP使用相关的主要因素包括医疗保险、有固定的医疗服务提供者、既往艾滋病病毒检测、既往使用过PrEP或暴露后预防、社交网络和耻辱感。尽管MSM中PrEP的使用比例仍然较低，但近年来有所增加。需要更多研究来探索与PrEP使用相关的因素，特别是针对低收入和中等收入国家中符合PrEP使用条件的MSM。
