Factors influencing uptake of pre-exposure prophylaxis: some qualitative insights from an intervention study of men who have sex with men in China

Liu, Chunxing; Ding, Yingying; Zhang, Ning; Gao, Min; Liu, Xing; Wong, Frank Y.; He, Na

doi:10.1071/sh17075

Cited by 32 publications

(35 citation statements)

References 23 publications

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“…PrEP among study participants, this was consistent with previous studies among Chinese MSM [36,37] and MSM in other countries [38]. While there are some side effects when first starting the medication, such as nausea and frequent vomiting, they usually abate after two months into the regimen [4,39].…”

Section: Concerns Of Side Effects Have Been Identified As One Of the supporting

confidence: 89%

Barriers and facilitators of Pre-exposure Prophylaxis (PrEP) intention among Chinese men who have sex with men

et al. 2020

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BackgroundDespite strengthened efforts on HIV prevention and control, new HIV infections continue to increase among men who have sex with men (MSM) in China. Pre-exposure prophylaxis (PrEP), a highly effective HIV prevention tool, has recently been included in China’s Action Plan of HIV Prevention and Control. To inform future PrEP implementation, this study aims to identify the barriers and facilitators of PrEP intention among MSM in China. MethodsIn 2018, a cross-sectional survey was conducted among 300 MSM in Nanjing, Jiangsu Province. Questions on demographics, sexual behavior (including a 7-item high-risk behavior index), PrEP use intention, PrEP-related awareness and accessibility, and a 7-item public HIV stigma scale were included in the questionnaire. Bivariate and multivariate logistic regression analyses were conducted to identify factors associated with PrEP intention. ResultsOverall, 44.67% had more than 2 male sexual partners and 5.56% had HIV-positive sexual partners. Just 57.00% had heard of PrEP and only 4 (1.33%) participants had used PrEP. However, 75.34% expressed a willingness to use oral PrEP if its efficacy was assured. Beliefs that ‘PrEP can prevent HIV if taken as prescribed’ (aOR=4.84, p<0.001), and ‘PrEP can be scaled up in the community’ (aOR=3.24, p<0.001), were positively associated with oral PrEP intention. Concerns of side effects were negatively associated with oral PrEP intention (aOR=0.32, p =0.006). Respectively 77.00% of the participants would choose injectable or implanted PrEP instead of oral PrEP. One of the PrEP stigma items, ‘Not certain if doctors can prescribe PrEP if I go to the clinic’ was positively associated with the intention to use injectable or implanted PrEP (aOR=3.03). Individuals who had heard of PrEP (aOR=2.74) and believed ‘PrEP can prevent HIV if taken as prescribed’ (aOR=2.65) were also positively related to the intention to use injectable or implanted PrEP. The most common concerns regarding PrEP use were efficacy (44.67%) and side effects (38.67%). The most common reasons for using injectable and implanted PrEP were adherence (81.94% and 77.86%, respectively) and privacy concerns (56.48% and 55.00%, respectively). Affordable price and coverage of health insurance are the driving factors for using PrEP. ConclusionsGiven the relatively low awareness of PrEP-related information in China, interventions on awareness and knowledge targeting high risk individuals and communities are needed. Furthermore, additional alternatives to prevent HIV, such as long-acting injectable or implanted PrEP, should be investigated to reduce the risk of HIV infection in at-risk MSM. Particularly, it is necessary to develop a more supportive social environment for MSM when implementing PrEP programs that are approved by China’s FDA.

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Section: Concerns Of Side Effects Have Been Identified As One Of the supporting

confidence: 89%

Barriers and facilitators of Pre-exposure Prophylaxis (PrEP) intention among Chinese men who have sex with men

et al. 2020

Preprint

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“…However, we also found that a high proportion of MSM reporting high-risk behavior do not perceive themselves at high-risk for HIV (~60%). This difference was also observed in other studies conducted in different settings (22)(23)(24)(25)(26)(27)(28)(29)(30) and could reflect a dissonance between sexual behavior and HIV transmission knowledge. Previous studies have shown a relationship between sexual behavior or low HIV perceived risk and mistaken beliefs about HIV transmission and epidemiology (31,32).…”

Section: Discussionsupporting

confidence: 50%

How heterogeneous are MSM from Brazilian cities? An analysis of sexual behavior and perceived risk and a description of trends in awareness and willingness to use PrEP.

Torres

Marins

Veloso

et al. 2019

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Background: Brazil has the largest population of individuals living with HIV/AIDS in Latin America, with a disproportional prevalence of infection among gays, bisexuals and other men who have sex with men (MSM). Of relevance to prevention and treatment efforts, Brazilian MSM from different regions may differ in behaviors and risk perception related to HIV. Methods: We report on MSM living in 29 different cities: 26 Brazilian state capitals, the Federal District and two large cities in São Paulo state assessed in three web-based surveys (2016-2018) advertised on Grindr, Hornet and Facebook. Using logistic regression models, we assessed the association of risk behavior with HIV perceived risk as well as factors associated with high-risk behavior. Results: A total of 16,667 MSM completed the survey. Overall, MSM from the North and Northeast were younger, more black/mixed-black, of lower income and lower education compared to MSM from the South, Southeast and Central-west. Though 17% had never tested for HIV (with higher percentages in the North and Northeast), condomless receptive anal sex (previous 6 months) and high-risk behavior as per HIV Incidence Risk scale for MSM were observed for 41% and 64%, respectively. Sexual behaviors and HIV perceived risk had low variability by city and high-risk behavior was strongly associated with high HIV perceived risk. Younger age, being gay/homosexual, having a steady partner, binge drinking, report of sexually transmitted infection (STI) and ever testing for HIV were associated with increased odds of high-risk behavior. Awareness and willingness to use PrEP increased from 2016 to 2018 in most cities. Conclusions: Overall, MSM socio-demographic characteristics were heterogeneous among Brazilian cities, but similarities were noted among the cities from the same administrative region with a marked exception of the Federal District not following the patterns for the Central-West. Combination HIV prevention is most needed among young men who self-identify as gay/homosexual, report binge drinking or prior STI.

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“…PrEP awareness is important in increasing uptake. Liu et al, [12] identi es accurate consumer knowledge as key to PrEP implementation and use in addition to addressing other factors such as stigma, adherence and risk reduction. About (87.4%) of the respondents would consider taking PrEP everyday while at ongoing risk.…”

Section: Discussionmentioning

confidence: 99%

What determines pre-exposure chemoprophylaxis uptake among MSM in Nairobi? A cross-sectional study

Ndungu

Gichangi

Temmerman

2020

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Background:Pre-exposure prophylaxis (PrEP) is a biomedical approach for preventing the acquisition of HIV in populations at substantial risk for HIV. PrEP acceptability has been high among the men who have sex with men (MSM) but the uptake and adherence has been low. The study seeks to determine the determinants of PrEP uptake among the MSM.Methods: A cross-sectional exploratory study design was employed targeting MSM in Nairobi city and its environs. Purposive sampling was used to identify sites, where data was collected and snowballing technique employed to reach the respondents. The data was collected between November 2018 to June 2019.Results: Majority of the respondents were aged between 18-24 years at (64.75%). There was a significant association between frequency of HIV testing and ever used PrEP at a P- Value of 0.019. The place of last test and PrEP uptake was also associated at a P-Value of 0.019. A majority of the respondents at 181 (59.0%) indicated that they prefer blood self-test kit. Respondents who indicated that they prefer top were 132 (38.0%) with versatile being 142 (40.9%) and bottom at 73 (16.6%). Participants who were more aware of PrEP had a higher probability of taking PrEP at P-Value 0.002. There was an association between risk perception and taking PrEP at a P-Value of 0.0001. Some of the factors that hindered PrEP uptake include; Alcohol/drug use, there was a statistically significant association between anal sex after alcohol/hard drug use and never used PrEP at P-value of 0.027. Other factors include Stigma, discrimination, adherence and perceived side effects associated with the drugs.Conclusions: Our study shows a number of factors facilitate PrEP uptake including; being a young MSM, inconsistent condom use, frequent HIV testing, being tested for HIV in a drop in centre, reporting frequent receptive anal intercourse, being aware of PrEP, perceived high risk of HIV infection and the believe about the effectiveness of PrEP. Barriers to PrEP uptake include; concomitant PrEP use with alcohol or hard drugs, stigma, discrimination, adherence, perceived PrEP side effects and medical mistrust.

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Factors influencing uptake of pre-exposure prophylaxis: some qualitative insights from an intervention study of men who have sex with men in China

Abstract: Findings suggest that PrEP implementation strategies should first address issues including but not limited to accurate self-assessment of HIV risk, mistrust and limited knowledge about medical trials and PrEP, and ease of accessing PrEP.

Cited by 32 publications

References 23 publications

Barriers and facilitators of Pre-exposure Prophylaxis (PrEP) intention among Chinese men who have sex with men

Barriers and facilitators of Pre-exposure Prophylaxis (PrEP) intention among Chinese men who have sex with men

How heterogeneous are MSM from Brazilian cities? An analysis of sexual behavior and perceived risk and a description of trends in awareness and willingness to use PrEP.

What determines pre-exposure chemoprophylaxis uptake among MSM in Nairobi? A cross-sectional study

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