Risk Management on Pre-Exposure Prophylaxis Adherence of Men Who Have Sex with Multiple Men: A Multicenter Prospective Cohort Study

Jiaxiu Liu; Ruibin Deng; Bing Lin; Hong Pan; Yuwen Gao; Jianghong Dai; Hao Liang; Ailong Huang; Xiaoni Zhong

doi:10.2147/RMHP.S295114

Risk Management on Pre-Exposure Prophylaxis Adherence of Men Who Have Sex with Multiple Men: A Multicenter Prospective Cohort Study

Risk Manag Healthc Policy. 2021 Apr 28:14:1749-1761. doi: 10.2147/RMHP.S295114. eCollection 2021.

Authors

Jiaxiu Liu^{1

2}, Ruibin Deng¹, Bing Lin¹, Hong Pan¹, Yuwen Gao¹, Jianghong Dai³, Hao Liang⁴, Ailong Huang⁵, Xiaoni Zhong¹

Affiliations

¹ School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, People's Republic of China.
² School of Medical Information, Chongqing Medical University, Chongqing, People's Republic of China.
³ Department of Epidemiology and Health Statistics, School of Public Health, Xinjiang Medical University, Xinjiang, People's Republic of China.
⁴ Department of Epidemiology and Medical Statistics, School of Public Health, Guangxi Medical University, Nanning, People's Republic of China.
⁵ Key Laboratory of Molecular Biology on Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, People's Republic of China.

Abstract

Background: Men who have sex with multiple men (MSMM) belong to a high-risk group for HIV infection, and pre-exposure prophylaxis (PrEP) is an effective measure to prevent the infection. However, few studies on PrEP adherence by MSMM in China exist. We aimed to explore the protective motivation-related factors for PrEP adherence in an HIV-negative MSMM population in Western China and to provide a reference for future risk management and effective prevention strategies.

Methods: Data were collected from a 2-year follow-up cohort study of PrEP in MSM in China. Rogers' protective motivation theory (PMT) was used to study the PrEP adherence of MSMM, and logistic regression was performed to analyze the influencing factors of PrEP adherence.

Results: A total of 496 MSMM were included in the study: 299 (60.28%) of them in the good adherence group and 197 (39.72%) in the poor adherence group. The threat assessment scores of the good and poor adherence groups were 2.15 ± 0.59 and 2.06 ± 0.47, respectively, and the response assessment scores were 2.81 ± 0.62 and 2.74 ±0.62, respectively. Poor PrEP adherence was associated with on-demand PrEP medication (OR=0.670), students at school (OR=1.837), occasional condom use (OR=1.621), and good HIV knowledge (OR= 0.659). The higher the threat assessment score, the higher the susceptibility; and the lower the response cost, the stronger the protection motivation and the less likely MSMM were to have poor adherence.

Conclusion: On-demand PrEP medication is more conducive to adherence. Preventive management should focus on MSMMs who are students at school, those who occasionally use condoms, and those with poor HIV knowledge. Improving threat perception and susceptibility, and controlling and reducing the response cost can effectively improve PrEP adherence, and the subsequent application of PMT during intervention research can provide a reference for HIV prevention in MSMM.

Keywords: MSM; PrEP; Western China; adherence; multiple sexual partners; protective motivation theory.

Grants and funding

This work was supported by the National Key Project for Infectious Diseases of the Ministry of Science and Technology of China (2012ZX10001007-007 and 2018ZX10721102-005); and Chongqing Science and Technology Commission (No. cstc2013jcyjA10009).