Fan Chengxin, Yin Zhuoheng, Li Chunyan, Dai Yifan, Zhao Heping, Marley Gifty, Li Quanmin, Wu Songjie, Huang Haojie, Hazra Aniruddha, Lio Jonathan, Liang Ke, Li Linghua, Sherer Renslow, Tucker Joseph D, Tang Weiming
School of Public Health, Nanjing Medical University, No. 101 Longmian St, Nanjing, 211166, China.
University of North Carolina Project-China, Guangzhou, China.
AIDS Behav. 2025 Jun;29(6):1831-1840. doi: 10.1007/s10461-025-04651-9. Epub 2025 Feb 10.
Peer referral leverages social networks to connect individuals with health services, potentially enhancing pre-exposure prophylaxis (PrEP) use. This study aims to investigate the impact of peer referral on PrEP adherence and persistence among men who have sex with men (MSM) in China. This study is nested in a 12-month PrEP (FTC/TDF) demonstration trial in China from September 2021 to December 2023. Peer referral was defined as participants being referred by peers already enrolled in the trial. PrEP adherence was measured as taking four or more pills per week for daily users or following the 2 + 1 + 1 event-driven regimen at least 75% of the time. PrEP persistence was defined as the time from initiation to discontinuation. We collected data from the first 6 months of follow-up and used generalized estimating equations and Cox regression models to evaluate the association between peer referral and PrEP adherence and persistence. A total of 1,131 MSM initiated PrEP, with 121 (10.7%) referred by peers. At month 6, adherence rates were 75.0% for peer-referred MSM and 67.1% for non-peer-referred MSM. Peer-referred MSM had higher adherence than non-peer-referred MSM (aRR = 1.11, 95% CI: 1.01-1.22). Regarding persistence, 812 (71.8%) MSM continued using PrEP at 6 months of follow-up, and peer-referred MSM were more likely to persist with PrEP (aHR = 1.85, 95% CI: 1.17-2.91). These findings demonstrate the potential of peer referral in promoting PrEP use among MSM, suggesting the value of powerful peer-based interventions like peer navigation in future PrEP outreach.
同伴推荐利用社交网络将个人与健康服务联系起来，有可能增加暴露前预防（PrEP）的使用。本研究旨在调查同伴推荐对中国男男性行为者（MSM）PrEP依从性和持续性的影响。本研究嵌套于2021年9月至2023年12月在中国进行的一项为期12个月的PrEP（FTC/TDF）示范试验中。同伴推荐定义为参与者由已参加该试验的同伴推荐。PrEP依从性的衡量标准是，每日使用者每周服用四片或更多片药物，或在至少75%的时间内遵循2+1+1事件驱动方案。PrEP持续性定义为从开始使用到停药的时间。我们收集了随访前6个月的数据，并使用广义估计方程和Cox回归模型来评估同伴推荐与PrEP依从性和持续性之间的关联。共有1131名MSM开始使用PrEP，其中121名（10.7%）由同伴推荐。在第6个月时，同伴推荐的MSM的依从率为75.0%，非同伴推荐的MSM的依从率为67.1%。同伴推荐的MSM比非同伴推荐的MSM具有更高的依从性（调整后风险比[aRR]=1.11，95%置信区间[CI]：1.01-1.22）。关于持续性，812名（71.8%）MSM在随访6个月时继续使用PrEP，同伴推荐的MSM更有可能持续使用PrEP（调整后风险比[aHR]=1.85，95%CI：1.17-2.91）。这些发现证明了同伴推荐在促进MSM中PrEP使用方面的潜力，表明在未来PrEP推广中，像同伴导航这样强大的基于同伴的干预措施具有价值。
