Wong Ngai Sze, Chan Denise Pui-Chung, Kwan Tsz Ho, Lui Grace Chung-Yan, Lee Krystal Chi-Kei, Lee Shui Shan
Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China.
S.H. Ho Research Centre for Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China.
AIDS Behav. 2024 Apr;28(4):1327-1344. doi: 10.1007/s10461-023-04167-0. Epub 2023 Sep 29.
Pre-exposure prophylaxis (PrEP) use has been shown to be effective for HIV prevention in men who have sex with men (MSM). PrEP use coverage aside, maintenance of high PrEP adherence is crucial in ensuring the achievement of HIV prevention. In this PrEP implementation study in Hong Kong, we examined the patterns of PrEP use in MSM and evaluated their association with prevention-effective adherence for HIV prevention. In January 2020-June 2021 in Hong Kong, 312 recruited MSM (median 30 years old) were followed up for 1 year, with HIV and creatinine testing, consultation, and PrEP refill. No HIV breakthrough infection was observed. As a measure of prevention-effective adherence, executed adherence (EA) was expressed as the proportion of days with HIV risk that were protected by PrEP and/or condom in 6 months. In 65,585 diary entries of 215 MSM, the median proportion of EA achieved was 89% (IQR 84-93%). Three latent classes of PrEP users were identified by latent class analysis. Taking Class 1 "daily dominant PrEP" (n = 113, 53%) as reference, Class 2 "episodic PrEP" (n = 76, 35%) was adopted by MSM with less sexual activity, had less PrEP refill and lower EA level, while Class 3 "mixed PrEP schedule" (n = 26, 12%) MSM were more sexually active but with a similar EA level. The study findings showed varied and dynamic PrEP usage patterns in the real-world setting. Strategies for promoting adherence are needed to ensure the maintenance of high EA level among PrEP-using MSM especially those on episodic PrEP schedule.
暴露前预防（PrEP）的使用已被证明对男男性行为者（MSM）预防艾滋病毒有效。除了PrEP的使用覆盖率外，保持高PrEP依从性对于确保实现艾滋病毒预防至关重要。在香港的这项PrEP实施研究中，我们研究了MSM中PrEP的使用模式，并评估了它们与预防艾滋病毒的有效依从性之间的关联。2020年1月至2021年6月在香港，对312名招募的MSM（中位年龄30岁）进行了1年的随访，包括艾滋病毒和肌酐检测、咨询以及PrEP补充。未观察到艾滋病毒突破性感染。作为预防有效依从性的一项指标，执行依从性（EA）表示为在6个月内受PrEP和/或避孕套保护的有艾滋病毒感染风险天数的比例。在215名MSM的65585条日记记录中，达到的EA中位比例为89%（四分位距84 - 93%）。通过潜在类别分析确定了三类PrEP使用者。以第1类“每日主导PrEP”（n = 113，53%）为参照，第2类“偶发性PrEP”（n = 76，35%）被性行为较少的MSM采用，PrEP补充较少且EA水平较低，而第3类“混合PrEP方案”（n = 26，12%）的MSM性行为更活跃，但EA水平相似。研究结果表明，在现实环境中PrEP的使用模式多样且动态变化。需要采取促进依从性的策略，以确保使用PrEP的MSM，尤其是那些采用偶发性PrEP方案的人，保持较高的EA水平。
