National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Danlan Goodness, Beijing, China.
J Med Internet Res. 2023 May 19;25:e42729. doi: 10.2196/42729.
To date, non-occupational postexposure prophylaxis (PEP) has been widely accepted as a safe and effective intervention for HIV in many countries, yet it remains an underutilized prevention strategy in China. Evidence indicated a high demand for PEP among Chinese men who have sex with men, but the uptake and access to PEP service remain limited. In an era of rapid development of web-based technology, online medical platforms in China hold great promise in facilitating PEP provision and delivery by addressing problems such as accessibility, convenience, privacy protection, and antidiscrimination by integrating online and offline resources. However, there is a paucity of data concerning the uptake and outcomes of online PEP in China.
The aim of this study is to explore online PEP service provision and understand PEP uptake and outcome through a web-based cross-sectional study.
From January 2020 to June 2021, we conducted a retrospective web-based survey among those seeking online PEP services via the internet medical platform "HeHealth" using a structured questionnaire. Participants were surveyed on sociodemographic characteristics, sexual and drug-related behaviors, history of preexposure prophylaxis (PrEP) usage, and PEP uptake. Statistical analysis included descriptive analysis, chi-square test, and multivariable logistic regression. P values <.05 were deemed statistically significant.
No HIV seroconversions were observed among 539 PEP users. Our sample demonstrated that most participants seeking online PEP services were gay (397/539, 73.7%), single (470/539, 87.2%), having an education of more than 12 years (493/539, 91.5%), and with an average monthly income of 7000 RMB (1 RMB=US $0.14) or more (274/539, 50.8%). Sexual exposures accounted for 86.8% (468/539) of the cases, with anal sex being the most common indication (389/539, 72.2%) for seeking PEP use. Among 539 participants, 60.7% (327/539) sought online PEP for relatively low-risk exposures, whereas 39.3% (212/539) were considered high-risk exposures. Nearly all (537/539, 99.6%) initiated PEP within 72 hours and 68.6% (370/539) within 24 hours of exposure. All users (539/539) were prescribed a 3-drug regimen, with most comprising 3TC/TDF+DTG (lamivudine, tenofovir disoproxil fumarate, and dolutegravir; 293/539, 54.4%), followed by FTC/TDF+DTG (emtricitabine, tenofovir disoproxil fumarate, and dolutegravir; 158/539, 29.3%). The adjusted model showed that greater odds of PrEP usage were associated with an age of 35 years or older versus the age group of 25-34 years (adjusted odds ratio [AOR] 2.04, 95% CI 1.24-3.37), having an education of 17 years or more versus an education of 12 years or less (AOR 3.14, 95% CI 1.29-7.62), average monthly income of 20,000 RMB or more versus less than 3000 RMB (AOR 2.60, 95% CI 1.09-6.23), and having high-risk sexual behavior during PEP treatment (AOR 2.20, 95% CI 1.05, 3.69).
The 0% infection rate in this study demonstrated that online PEP could be a valuable risk-reduction option to improve HIV prevention service within China. However, further research is needed to better facilitate PrEP transition among online PEP users.
迄今为止，许多国家已广泛接受非职业性暴露后预防（PEP）作为 HIV 的一种安全有效的干预措施，但在中国，这种预防策略仍未得到充分利用。有证据表明，中国男男性行为者（MSM）对 PEP 的需求很高，但 PEP 服务的获取和可及性仍然有限。在网络技术快速发展的时代，中国的在线医疗平台通过整合线上和线下资源，解决了可及性、便利性、隐私保护和反歧视等问题，为提供和交付 PEP 服务提供了巨大的潜力。然而，目前关于中国在线 PEP 的使用情况和结果的数据很少。
本研究旨在通过基于网络的横断面研究，探索在线 PEP 服务的提供情况，并了解 PEP 的使用情况和结果。
从 2020 年 1 月至 2021 年 6 月，我们通过互联网医疗平台“HeHealth”对寻求在线 PEP 服务的人群进行了回顾性的基于网络的调查，使用了结构化问卷。参与者接受了关于社会人口统计学特征、性行为和药物相关行为、PrEP 使用史以及 PEP 使用情况的调查。统计分析包括描述性分析、卡方检验和多变量逻辑回归。P 值<.05 被认为具有统计学意义。
在 539 名 PEP 用户中，没有观察到 HIV 血清转换。我们的样本表明，大多数寻求在线 PEP 服务的参与者是同性恋者（397/539，73.7%）、单身（470/539，87.2%）、接受过 12 年以上教育（493/539，91.5%），平均月收入为 7000 元人民币（1 元人民币=0.14 美元）或以上（274/539，50.8%）。性接触占所有暴露情况的 86.8%（468/539），其中肛交是最常见的 PEP 使用指征（389/539，72.2%）。在 539 名参与者中，60.7%（327/539）因相对低危暴露而寻求在线 PEP，而 39.3%（212/539）被认为是高危暴露。几乎所有（537/539，99.6%）参与者在暴露后 72 小时内开始接受 PEP，68.6%（370/539）在 24 小时内开始接受 PEP。所有使用者（539/539）都开了 3 种药物的处方，其中大多数包含 3TC/TDF+DTG（拉米夫定、替诺福韦酯和度鲁特韦；293/539，54.4%），其次是 FTC/TDF+DTG（恩曲他滨、替诺福韦酯和度鲁特韦；158/539，29.3%）。调整后的模型表明，与 25-34 岁年龄组相比，35 岁或以上年龄组（调整后的优势比 [AOR] 2.04，95%CI 1.24-3.37）、17 年或以上教育程度与 12 年或以下教育程度（AOR 3.14，95%CI 1.29-7.62）、20,000 元人民币或以上平均月收入与少于 3000 元人民币（AOR 2.60，95%CI 1.09-6.23）、PEP 治疗期间有高危性行为（AOR 2.20，95%CI 1.05-3.69）与 PrEP 使用相关。
本研究中 0%的感染率表明，在线 PEP 可以成为改善中国 HIV 预防服务的一种有价值的降低风险的选择。然而，需要进一步的研究来更好地促进在线 PEP 用户向 PrEP 的过渡。
