British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
BC Centre on Substance Use, Vancouver, BC, Canada.
BMC Public Health. 2023 Oct 30;23(1):2124. doi: 10.1186/s12889-023-17049-w.
BACKGROUND: The secondary impacts of the COVID-19 pandemic may disproportionately affect gay, bisexual, and other men who have sex with men (GBM), particularly related to HIV prevention and treatment outcomes. We applied syndemic theory to examine PrEP disruptions during the during the height of the COVID-19 pandemic in Vancouver, Canada. METHODS: Sexually-active GBM, aged 16 + years, were enrolled through respondent-driven sampling (RDS) from February 2017 to August 2019. Participants completed a Computer-Assisted Self-Interview every six months and data were linked to the BC PrEP Program (program responsible for publicly funded PrEP in the province) to directly measure PrEP disruptions. The analysis period for this study was from March 2018-April 2021. We used univariable generalized linear mixed models to examine (1) six-month trends for syndemic conditions: the prevalence of moderate/severe depressive or anxiety symptoms, polysubstance use, harmful alcohol consumption, intimate partner violence, and (2) six-month trends for PrEP interruptions among HIV-negative/unknown GBM. We also applied 3-level mixed-effects logistic regression with RDS clustering to examine whether syndemic factors were associated with PrEP interruptions. RESULTS: Our study included 766 participants, with 593 participants who had at least one follow-up visit. The proportion of respondents with abnormal depressive symptoms increased over the study period (OR = 1.35; 95%CI = 1.17, 1.56), but we found decreased prevalence for polysubstance use (OR = 0.89; 95%CI = 0.82, 0.97) and binge drinking (OR = 0.74; 95%CI = 0.67, 0.81). We also found an increase in PrEP interruptions (OR = 2.33; 95%CI = 1.85, 2.94). GBM with moderate/severe depressive symptoms had higher odds (aOR = 4.80; 95%CI = 1.43, 16.16) of PrEP interruptions, while GBM with experiences of IPV had lower odds (aOR = 0.38; 95%CI = 0.15, 0.95) of PrEP interruptions. GBM who met clinical eligibility for PrEP had lower odds of experiencing PrEP interruptions (aOR = 0.25; 95%CI = 0.11, 0.60). CONCLUSION: There were increasing PrEP interruptions since March 2020. However, those most at risk for HIV were less likely to have interruptions. Additional mental health services and targeted follow-up for PrEP continuation may help to mitigate the impacts of the COVID-19 pandemic on GBM.
背景：COVID-19 大流行的次生影响可能会不成比例地影响男同性恋者、双性恋者和其他与男性发生性关系的男性（GBM），特别是与 HIV 预防和治疗结果有关。我们应用综合征理论来研究 COVID-19 大流行高峰期在加拿大温哥华期间 PrEP 的中断情况。
方法：从 2017 年 2 月到 2019 年 8 月，通过 RDS（受访者驱动抽样）招募了年龄在 16 岁及以上的活跃 GBM。参与者每六个月完成一次计算机辅助自我访谈，数据与不列颠哥伦比亚省 PrEP 计划（负责该省公共资助 PrEP 的项目）相关联，以直接衡量 PrEP 的中断情况。本研究的分析期为 2018 年 3 月至 2021 年 4 月。我们使用单变量广义线性混合模型来检查：（1）综合征状况的六个月趋势：中度/重度抑郁或焦虑症状、多物质使用、有害饮酒、亲密伴侣暴力的流行率，以及（2） HIV 阴性/未知 GBM 中 PrEP 中断的六个月趋势。我们还应用了具有 RDS 聚类的 3 级混合效应逻辑回归来检查综合征因素是否与 PrEP 中断有关。
结果：我们的研究包括 766 名参与者，其中 593 名参与者至少有一次随访。在研究期间，有异常抑郁症状的受访者比例增加（OR=1.35；95%CI=1.17，1.56），但我们发现多物质使用（OR=0.89；95%CI=0.82，0.97）和 binge 饮酒（OR=0.74；95%CI=0.67，0.81）的流行率下降。我们还发现 PrEP 中断增加（OR=2.33；95%CI=1.85，2.94）。有中度/重度抑郁症状的 GBM 中断 PrEP 的可能性更高（aOR=4.80；95%CI=1.43，16.16），而经历过 IPV 的 GBM 中断 PrEP 的可能性较低（aOR=0.38；95%CI=0.15，0.95）。符合 PrEP 临床资格的 GBM 中断 PrEP 的可能性较低（aOR=0.25；95%CI=0.11，0.60）。
结论：自 2020 年 3 月以来，PrEP 中断的情况有所增加。然而，那些感染 HIV 风险最高的人却不太可能中断 PrEP。增加心理健康服务和针对 PrEP 延续的后续行动可能有助于减轻 COVID-19 大流行对 GBM 的影响。
Int J Environ Res Public Health. 2021-10-30
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