| 石安霞,Don Operario,张志华,赵越,朱晓芳,杨璀,Nickolas Zaller,高攀,王君,孙业桓,张洪波.男男性行为人群HIV暴露前预防需求与使用障碍研究[J].中华流行病学杂志,2020,41(3):343-348 |
| 男男性行为人群HIV暴露前预防需求与使用障碍研究 |
| Needs of pre-exposure prophylaxis for HIV infection and related barriers among men who have sex with men |
| 收稿日期:2019-04-19 出版日期:2020-04-01 |
| DOI：10.3760/cma.j.issn.0254-6450.2020.03.012 |
| 中文关键词: 艾滋病病毒 男男性行为人群 暴露前预防 需求 |
| 英文关键词: HIV Men who have sex with men Pre-exposure prophylaxis Need |
| 基金项目:美国国立精神卫生研究院（R34MH106349） |
| 作者 | 单位 | E-mail | | 石安霞 | 安徽医科大学公共卫生学院流行病与卫生统计学系, 合肥 230032 | | | Don Operario | 布朗大学公共卫生学院社会与行为学系, 美国罗德岛州普罗维登斯市 | | | 张志华 | 安徽医科大学公共卫生学院流行病与卫生统计学系, 合肥 230032 | | | 赵越 | 安徽医科大学公共卫生学院流行病与卫生统计学系, 合肥 230032 | | | 朱晓芳 | 安徽医科大学公共卫生学院流行病与卫生统计学系, 合肥 230032 | | | 杨璀 | 约翰霍普金斯大学彭博公共卫生学院社会与健康及行为系, 美国马里兰州巴尔的摩市 | | | Nickolas Zaller | 阿肯色大学医学院健康教育与健康行为系, 美国阿肯色州小石城市 | | | 高攀 | 安徽青卫公共健康服务中心, 合肥 230061 | | | 王君 | 安徽医科大学公共卫生学院儿少卫生与妇幼保健学系, 合肥 230032 | | | 孙业桓 | 安徽医科大学公共卫生学院流行病与卫生统计学系, 合肥 230032 | | | 张洪波 | 安徽医科大学公共卫生学院流行病与卫生统计学系, 合肥 230032 | zhanghongbo@ahmu.edu.cn |
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| 中文摘要: |
| 目的 了解MSM对HIV暴露前预防（PrEP）的实际需求及阻碍其使用的相关因素。方法 通过同性社交Blued 6.5.0软件、MSM同伴推荐等方法招募MSM为调查对象，估算样本量600人。利用"问卷星"平台，在调查员的指导下进行匿名电子问卷调查，调查内容包括一般情况、PrEP相关知识和使用意愿与顾虑、PrEP实际需求及PrEP使用自我效能等。结果 共调查622名MSM，知晓和曾使用过PrEP的比例分别为56.4%（351/622）和4.3%（27/622）；67.2%（418/622）有PrEP实际需求，PrEP使用自我效能良好的为21.2%（132/622）。结构方程模型分析结果显示，PrEP相关知识和使用顾虑对PrEP使用自我效能发挥直接正向作用，效应系数分别为0.08和0.13，自我歧视是由于PrEP使用顾虑而间接影响PrEP使用自我效能，效应系数为0.035；广义线性混合模型分析结果表明，曾使用过PrEP可增加使用自我效能（OR=5.55）；PrEP相关知识和使用顾虑每增加1分，PrEP使用自我效能分别增加0.14倍和0.07倍。担心药物副作用、预防效果和费用者分别占61.1%（380/622）、60.1%（374/622）和53.2%（331/622）；期望获取PrEP服务途径主要为CDC（75.6%，470/622）、MSM社会组织（65.4%，407/622）和互联网（63.8%，397/622）。结论 MSM对PrEP呈现高需求与低使用的较大差距，PrEP相关知识缺乏、自我歧视、对药物预防效果、副作用及费用的顾虑是阻碍MSM使用PrEP的因素，故需要建立适合MSM特点的PrEP服务模式，以满足MSM对PrEP干预的需求。 |
| 英文摘要: |
| Objective To understand the actual needs for the pre-exposure prophylaxis (PrEP) for HIV infection and the factors hindering PrEP utilization in men who have sex with men (MSM). Methods Participants were recruited by using MSM social application software Blued 6.5.0 and through MSM peer referral, sample size was 600. An electronic questionnaire survey was conducted anonymously with guidance of investigators via "Questionnaire Star" platform. The contents of the survey included demographic characteristics of the participants, the awareness of PrEP related knowledge, willingness and concerns about using PrEP, actual need for PrEP and self-efficacy of using PrEP. Results A total of 622 MSM completed the survey, of whom 56.4% (351/622) and 4.3% (27/622) ever heard of and received PrEP, respectively. The need assessment of PrEP showed that 67.2% (418/622) of the participants had actual needs for PrEP and 21.2% (132/622) used PrEP with good self-efficacy. Structural equation modeling analysis showed that the awareness of PrEP related knowledge and concerning about PrEP utilization in MSM played a direct positive role in their self-efficiency of using PrEP, and the effect coefficients were 0.08 and 0.13, respectively. MSM self-discrimination indirectly affected the self-efficiency of using PrEP through concerns about PrEP use, the effect coefficient was 0.035. The result of generalized linear mixed model analysis demonstrated that the utilization of PrEP can improve the self-efficacy of using PrEP (OR=5.55), which increased by 0.14 times and 0.07 times with the increase of 1 score of the awareness of PrEP related knowledge and concern about using PrEP respectively. In addition, this survey found that in the participants, the main concerns about using PrEP were side effects, HIV prevention effect and its expense, accounting for 61.1% (380/622), 60.1% (374/622) and 53.2% (331/622), respectively. Most participants hoped to obtain PrEP services from CDC, MSM social organization and internet, accounting for 75.6% (470/622), 65.4% (407/622), and 63.8% (397/622), respectively. Conclusions MSM showed difference of high need but low utilization of PrEP services. Low awareness of PrEP related knowledge, concerns about the prevention effect, side effects and expense of PrEP as well as self-discrimination were the factors hindering the use of PrEP in MSM. It is necessary to establish a suitable PrEP service model to meet the needs for PrEP in MSM. |
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