Adherence To Pre-exposure Prophylaxis Among Men Who Have Sxe With Men Based On The Theory Of Information-Motivation-Bahavior Techniques

Objective: Several clinical trials have shown that pre-exposure prophylaxis can effectively prevent HIV infection,but its effectiveness is based on adherence.Therefore,the purpose of this study was to evaluate the adherence to MSM population in Chongqing,Sichuan,Guangxi and Xinjiang in clinical trials.Based on the theory of information-motivationbehavior skills,this paper discusses the social psychological factors affecting PrEP adherence,and explores the hindrance factors and promoting factors of PrEP adherence in this group,which provides a reference for the clinical study of PrEP in MSM population.Methods: From April 2013 to March 2015,four research sites in western China,Chongqing,Guangxi,Xinjiang and Sichuan,were used to recruit subjects and carry out clinical trials of PrEP using non-probabilistic sampling method.The clinical trial of PrEP was conducted between April 2013 and March 2015 in Chongqing,Guangxi,Xinjiang and Sichuan.The subjects were randomly divided into three groups: daily oral TDF group,intermittent oral TDF group and blank control group.Face-to-face follow-up and HIV testing were conducted every 3 months for 2 years.The data were collected by questionnaire.Firstly,the theory model of informationmotivation-behavior skills is established,which is verified by Amos-24 software and structural equation model.At the same time,using SAS 9.2software,statistical description and univariate Logistic regression were used to analyze the hindrance factors and promoting factors of preventive drug adherence in MSM population before exposure.Results:(1)A total of 856 MSM,patients were enrolled in the study,of which 385 MSM were assigned to the daily oral TDF group and 471 MSM were assigned to the intermittent TDF group.The majority of MSM participants were urban hukou(74.39%),Han nationality(91.24%),employed(79.02%),unmarried(73.95%),specialized and undergraduate students(62.65%),and tested for AIDS(81.85%).Among MSM subjects,20.56%MSM had anxiety and 48.6%MSM had depressive symptoms.The MSM sexual role was active in 49.71%,and Internet searching for sexual partners accounted for 57.28%.Multiple sexual partners accounted for 8.85% and 4.39% of 48.13%.MSM subjects who had been diagnosed with venereal diseases,had commercial sex and used drugs in the last six months.2.98%.(2).The average drug taking rate of MSM subjects was(0.62 ±0.34).The median level was 0.71(rang: 0.00-1.00).Among them,the daily TDF rate of MSM was(0.59 ±0.34),the median level was 0.34(rang:0.00~1.00).In intermittent TDF group,the medication rate was(0.65±0.34)and the median level was 0.75(rang:0.00~1.00).In the daily oral TDF group,124(32.21%)were high adherence,142(36.88%)were intermediate adherence,and 119(30.91%)were low adherence Among the intermittent TDF groups,212(45.01%)had high adherence,150(31.85%)had intermediate adherence,109(23.14%)had low adherence.(3)The factor path analysis of the final IMB model showed that AIDS knowledge score and PrEP motivation had a certain correlation to the behavior skills required by PrEP,and the path coefficients were respectively 0.21 and 0.14.However,there was no significant correlation between AIDS-related information,PrEP-related motivation and behavior skills and PrEP adherence,which suggested that AIDS knowledge score,PrEP motivation had a certain impact on the behavior skills required by PrEP,but AIDS-related information.PrEP-related motivation and behavioral skills had no effect on PrEP adherence.(4)Logistic regression analysis showed that the factors influencing PrEP adherence included taking drugs,seeking sexual partners through the Internet,and HIV testing.The PrEP adherence to the intermittent TDF was 1.604 times higher than that to the daily oral TDF group(OR95%CI=1.248,2.063),and the PrEP compliance of the subjects who had been tested for HIV was 1.469 times as much as that of the control group(OR95%CI=1.064,2.029),while that of the control group was 1.604 times higher than that of the control group(OR 95%CI=1.248,2.063).During the follow-up period(OR95%CI=1.167,1.950).(5)A total of 692 people(80.84%)in the drug group had missed taking the PrEP compliance to find sexual partners through the Internet as compared with that of the non-Internet seeking partner subjects(OR 95% CI 1.167,1.950).(4)during the follow-up period,a total of 692 people(80.84%)in the drug-taking group had missed taking medicine,and the number of missed-taking cases was 1909 person-times.The reasons for self-reported non-adherence were "forgetting to take medicine"(1011,52.96%)and "not taking medicine"(325,17.02%)."worrying about side effects"(298,15.61%),"too busy and no time"(200,10.48%),"taking medicine too much trouble"(193,10.11%),"taking other drugs at the same time"(59,3.10%),"drug efficacy is not good"(35 times,1.8%)and "side effects"(14 times,0.73%).Conclusions:(1)The PrEP adherence to MSM population in Chongqing,Sichuan,Guangxi and Xinjiang in western China showed moderate level,which should be strengthened by effective measures.(2)To improve the PrEP adherence to MSM population in Chongqing,Sichuan,Guangxi and Xinjiang.The combination of traditional health education and multi-path compliance strategy is needed.The corresponding departments should take certain behavioral intervention and mental health prevention measures,and use electronic devices to remind men to take drugs regularly,which may improve PrEP adherence to a certain extent,and further reduce the infection rate of HIV.The strategy of preventive drug compliance before exposure needs to be further explored.