Mapping Potential Pre-Exposure Prophylaxis Users onto a Motivational Cascade: Identifying Targets to Prepare for Implementation in China

Wu, Yumeng; Xie, Luyu; Meng, Siyan; Hou, Jun; Fu, Rong; Huang, Zheng; He, Na; Meyers, Kathrine

doi:10.1089/lgbt.2018.0256

Cited by 27 publications

(23 citation statements)

References 61 publications

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“…However, with the expiration of drug (TDF) patents, the increase in market competition, and the decrease in price of TDF in China (from around CNY 1500 to 500 per month) [34], a substantial decline in the price of PrEP is expected in the future in China. Recently, the motivational PrEP cascade was put forward and used as a conceptual tool for identifying discrepancies between willingness and behavior [35,36]. The motivational PrEP cascade involves five stages: (1) Stage 1, unwilling to take PrEP, (2) Stage 2, willing to take PrEP, (3) Stage 3, in PrEParation (i.e., seeing PrEP as accessible and planning to initiate PrEP), (4) Stage 4, in PrEP action (i.e., prescribed PrEP), and (5) Stage 5, maintenance and adherence.…”

Section: Discussionmentioning

confidence: 99%

Willingness to Use and Adhere to HIV Pre-Exposure Prophylaxis (PrEP) among Men Who Have Sex with Men (MSM) in China

Peng

Cao

et al. 2019

IJERPH

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This study aimed to investigate the levels of willingness to use pre-exposure prophylaxis (PrEP) and intention to adhere to PrEP and to further explore factors associated with PrEP uptake among men who have sex with men (MSM) in China. A total of 524 MSM were recruited from Chengdu, China. Half of the participants had heard of PrEP, and the awareness rate varied from 33.8%, 30.7%, and 7.1% for daily oral PrEP, on-demand PrEP, and long-acting injectable PrEP (LAI-PrEP), respectively. The overall willingness to use any type of PrEP in the next six months was 84.9% if PrEP is effective and provided for free. Participants were less likely to say that they would use PrEP if they used a condom consistently with their regular partners. However, participants were more likely to say that they would use PrEP if they had casual partners in the past month and had higher HIV prevention literacy. The majority of participants intended to adhere to PrEP prescription. More than forty percent (43.1%) of the participants reported that they might reduce condom use if they took PrEP. We found that the overall willingness to use PrEP was high among MSM living in China, but willingness varied across the different types of PrEP.

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Section: Discussionmentioning

confidence: 99%

Willingness to Use and Adhere to HIV Pre-Exposure Prophylaxis (PrEP) among Men Who Have Sex with Men (MSM) in China

Peng

Cao

et al. 2019

IJERPH

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“…Similarly, data for this analysis were collected prior to March 2016 and it is possible the prevalence of risk behaviours or willingness to report risk behaviours may differ in 2020. As a comparison point, a recent cross‐sectional analysis published in 2019 used a modified version of the USPHC PrEP eligibility assessment tool and found 45.6% of surveyed MSM in China met the eligibility requirements [32]. Additional studies should replicate this approach in different settings to assess the appropriateness of a set of guidelines in their specific context.…”

Section: Discussionmentioning

confidence: 99%

Assessing the performance of international pre‐exposure prophylaxis (PrEP) eligibility guidelines in a cohort of Chinese MSM, Beijing, China 2009 to 2016

Hall

Wang²,

Huang

et al. 2020

J. Intern. AIDS Soc.

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Introduction PrEP is a powerful HIV prevention tool, and locally relevant eligibility criteria are necessary to optimize the prevention impact of PrEP. We assessed performance of existing national and international PrEP eligibility criteria to predict future HIV seroconversion among MSM in Beijing, China. Methods Participants were MSM aged ≥18 years who enrolled in a cohort study between July 2009 and March 2016. Participants completed HIV testing, syphilis testing, and a questionnaire on recent sexual health behaviours at each follow‐up visit and were followed until HIV seroconversion or dropout. We assessed PrEP eligibility at the most recent follow‐up visit prior to the final study visit. Participants were classified as indicated for PrEP (or not) based on criteria from guidelines from Europe, Korea, South Africa, Taiwan, the United Kingdom, United States and the World Health Organization. To compare guideline performance, we calculated sensitivity, specificity, Youden’s Index (YI), Matthew’s Correlation Coefficient (MCC), F1 scores and diagnostic odds ratios. For each guideline, performance measures were compared to random allocation of PrEP by randomly selecting a proportion of participants equal to the proportion indicated. Results There were 287 (17∙3%) incident HIV seroconversions among 1663 MSM. The number of men indicated for PrEP from different guidelines ranged from 556 (33∙4%) to 1569 (94∙2%). Compared to random allocation, sensitivity of algorithms to predict seroconversion ranged from slightly worse (−4∙7%) to 30∙2% better than random. However, in absolute terms, none of the sensitivity values increased by more than 11% when compared to random allocation. For all guidelines, specificity was not meaningfully better than random allocation. No guidelines had high binary classification performance measures. Conclusions The performance of international indication guidelines in this sample was only slightly better than random allocation. Using such guidelines to screen out MSM self‐identifying as interested in PrEP could lead to misallocation of resources and to good candidates for PrEP being denied access. For settings in which international guidelines perform poorly, alternative indication approaches should be considered.

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“…Our previous studies among potential PrEP users identified the need for gain-framed messaging when promoting PrEP to avoid such stigma [24,54]. Our training therefore adopted a sex-positive approach to empower lay HIV workers to accurately communicate potential benefits of PrEP and avoid stigmatizing approaches (such as promoting PrEP as a strategy for people with "very high risk" of HIV) [24,53,54] as a stigma-mitigation strategy. As China is on the cusp of PrEP implementation, it is critical to devise strategies to integrate PrEP into health services without introducing PrEP stigma against potential users.…”

Section: Discussionmentioning

confidence: 99%

Acceptability, Appropriateness, and Preliminary Effects of the PrEP Diffusion Training for Lay HIV Workers: Increased PrEP Knowledge, Decreased Stigma, and Diffusion of Innovation

Ye²,

Meyers³

2020

Preprint

Self Cite

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Background Training lay health workers is a critical strategy for HIV pre-exposure prophylaxis (PrEP) implementation, but little is known about effective approaches to conducting and evaluating such trainings. We evaluated the effect of the PrEP Diffusion Training, a one-day participatory training informed by the Diffusion of Innovation theory, on knowledge, PrEP stigma, implementation behavior, and diffusion of PrEP innovation among lay HIV workers in China.Methods Nine PrEP Diffusion Trainings were delivered to 220 lay HIV workers. We conducted multi-time-point surveys to assess acceptability, appropriateness, and preliminary effects of the training on participants’ knowledge, PrEP stigma, determinants of implementation behavior, and diffusion of PrEP information. We used an observation-based checklist to evaluate implementation fidelity.Results All trainings were delivered with high fidelity to the standardized manual, with little variability across sites. Acceptability and appropriateness of training were high. PrEP knowledge score significantly increased by 65% from pre-training to post-training, and remained high one month after the training. We observed a significant decrease in PrEP stigma and a positive influence on determinants of implementation behaviors. All participants surveyed one-month after the training reported having shared PrEP information in their social networks, and 43% reported integrating PrEP education into their routine HIV prevention work on a regular basis.Conclusions The PrEP Diffusion Training is a practical and effective strategy to build lay HIV workers’ capacity to participate in PrEP implementation. Longer-term follow up post training would be ideal to further assess actual PrEP uptake and sustained effects of intervention on PrEP implementation.

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Mapping Potential Pre-Exposure Prophylaxis Users onto a Motivational Cascade: Identifying Targets to Prepare for Implementation in China

Cited by 27 publications

References 61 publications

Willingness to Use and Adhere to HIV Pre-Exposure Prophylaxis (PrEP) among Men Who Have Sex with Men (MSM) in China

Willingness to Use and Adhere to HIV Pre-Exposure Prophylaxis (PrEP) among Men Who Have Sex with Men (MSM) in China

Assessing the performance of international pre‐exposure prophylaxis (PrEP) eligibility guidelines in a cohort of Chinese MSM, Beijing, China 2009 to 2016

Acceptability, Appropriateness, and Preliminary Effects of the PrEP Diffusion Training for Lay HIV Workers: Increased PrEP Knowledge, Decreased Stigma, and Diffusion of Innovation

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