Risk-Taking Behaviors and Adherence to HIV Pre-Exposure Prophylaxis in Users of Geosocial Networking Apps: Real-World, Multicenter Study

Abstract

Background Over half of men who have sex with men (MSM) use geosocial networking (GSN) apps to encounter sex partners. GSN apps’ users have become a unique large subpopulation among MSM for interventions concerning HIV prevention and control. Pre-exposure prophylaxis (PrEP) is a promising measure for HIV prevention, especially for MSM, but its effectiveness largely depends on medication adherence. However, little is known about PrEP adherence among GSN apps’ users, which is critical to addressing the overall optimization of PrEP compliance outside of clinical trials in the context of large-scale implementation. Objective The objective of this study is to understand the correlation between GSN apps’ use and medication adherence among MSM receiving PrEP, with the aim to increase their awareness about PrEP use in order to increase adherence. Methods This study based on the China Real-world Oral intake of PrEP (CROPrEP) project, a multicenter, real-world study of Chinese MSM on daily and event-driven PrEP. Eligible participants completed a detailed computer-assisted self-interview on sociodemographic, GSN apps’ use, and sexual behavior. Then participants were followed up for 12 months and assessed for various characteristics (eg, PrEP delivery, adherence assessment, PrEP coverage of sexual activities, and regimens switch). A generalized estimation equation was used to analyze the predictors of medication adherence and regimen conversion among GSN apps’ users and nonusers. Results At baseline, 756 of the 1023 eligible participants (73.90%) reported primarily using GSN apps to seek sexual partners, and GSN apps’ users are more likely to have high-risk behaviors such as multiple sex partners and condomless anal intercourse than other nonusers (all P<.05). During follow-up, GSN apps’ users had a significantly low level of pill-counting adherence than nonusers (adjusted odds ratio [aOR] 0.8, 95% CI 0.6-1.0, P=.038). In the event-driven group, GSN apps’ users had marginally lower levels of self-reported adherence (aOR 0.7, 95% CI 0.4-1.0, P=.060) and lower PrEP coverage of sexual practices (aOR 0.6, 95% CI 0.4-1.0, P=.038). Additionally, GSN apps’ users seemed more likely to switch from event-driven to daily regimen (aOR 1.8, 95% CI 0.9-3.3, P=.084). Conclusions GSN apps’ users are highly prevalent among MSM, despite their higher sexual risk and lower adherence levels, suggesting that eHealth needs to be introduced to the GSN platform to promote PrEP adherence. Trial Registration Chinese Clinical Trial Registry ChiCTR-IIN-17013762; https://tinyurl.com/yy2mhrv4. International Registered Report Identifier (IRRID) RR2-10.1186/s12879-019-4355-y

The Influencing Factors of HIV-Preventive Behavior Based on Health Belief Model among HIV-Negative MSMs in Western China: A Structural Equation Modeling Analysis

“…Men who have sex with men (MSMs) constitute the main key population of HIV-infected individuals, and over 95% of HIV infections in China were sexually transmitted [ 3 ]. The risk of HIV infection in MSMs is about 20 times that in the general population on average [ 4 ], and more than 25% of MSMs comprise new HIV infection cases in China despite various interventions having been adopted [ 5 , 6 ]. Western China has the highest number of HIV/AIDS new infections in China, accounting for 45% of new HIV/AIDS cases in China [ 7 ].…”

“…However, the effectiveness of PrEP largely depends on medication adherence according to the ninth International AIDS Society conference (WHO, 2017) on HIV science in 2017 and our previous research [ 11 , 12 , 13 ]. Adherence may be the most vital determinant factor affecting PrEP effectiveness, and improving adherence has become a common topic accompanied by evidence from existing studies [ 4 ].…”

Acceptability of HIV pre-exposure prophylaxis in China: A systematic review and meta-analysis

“…China started a pilot program for PrEP in 2018 14 and continues to do so. 15 A multicenter, real-world study 16 (CROPrEP) of HIV pre-exposure evaluating PrEP provision, effectiveness, clinical evaluation, laboratory testing, sexual behaviors, adherence, and attitudes in about 1000 MSM has only reported the research results of the correlation between geosocial networking apps and adherence, 17 the preference for daily and on-demand PrEP, and the impact of HIV self-testing on risk compensation of PrEP users. 18 Although China’s first HIV PrEP drug Truvada was approved in August 2020, there are no official guidelines yet.…”

Usability and effectiveness of adherence monitoring of a mobile app designed to monitor and improve adherence to event-driven and daily HIV pre-exposure prophylaxis among men who have sex with men in Taiwan

“… 59 Conversely, low adherence to ED PrEP was found among MSM and transgender women in Thailand and the United States in the HPTN 067/ADAPT study, and among MSM who sought sex partners via geosocial networking apps in China. 60 – 62 A high level of PrEP adherence in our study may be attributable to the flexibility of choosing PrEP dosing regimens and using an app. The possible explanations for the low adherence from the other two studies were that participants were assigned to one PrEP dosing regimen group without a cross-over in the HPTN 067/ADAPT study, and the participants had more frequent substance use in the Chinese study.…”